Monday, September 27, 2010

Fever, fear, plague Amravati--II

Fifty-year-old Nirmala Pawar is fatigued, anemic, and tired of sickness over the last fortnight. “For a week,” she says, “I am unable to work on farms.” Which in turn means her husband has to work extra or hire a hand for Rs 120 daily, given this year’s un-abating rains. “For three months, it’s been work, work and work.”

In Surali village of Amravati’s Warud tehsil, Nirmalabai is taking a typhoid dose intra-venous at a private clinic run in his home by Dr Rajesh Fate. Alongside is a 60-year-old Ramkisan Kadu, who, like her, looks tired, and wrought in tension.

“It’s a double blow,” Kadu, a farmer from the neighbouring Kurali village with suspected typhoid, says. Farm expenses shot up three fold this year. Now come the health expenses. He says the families like him are mortgaging gold and silver to buy health care. He has done it. “I am old, but can’ stop working,” he says.

By the evening, both of them will return home, to come here the next morning to take another dose of medicines.

“What to do!” he doctor says. “There is no room at the rural hospital at Warud.”
The 30-bed hospital in the tehsil town is overflowing with patients; waiting list is growing with every passing day; and the daily OPD (out patient department) has swollen to 500. Private hospitals in this small town are choc a bloc with patients.

Rural Amravati, the home district of President Pratibha Patil, is exploding with a deadly combination of viral infections and influenza. Rains have taken a break, but humid weather has unleashed a wave of health exigencies unseen before. At least 45 patients from a cluster of 15 villages in the orange county of Warud have died in a month, even as the rural hospital and the primary health centers lacked medicines.

Now, after the damage is done, the health machinery has woken up.

At least ten of these deaths were due to swine flu, health officials say. In Warud, a separate 10-bed ward has been set for the suspected swine flu (H1N1) patients. As reported by DNA earlier, medicine paucity only aggravated the problem – a fact admitted by health minister Suresh Shetty on his visit here last Saturday. On the night before his visit, Warud rural hospital got two trucks load of medicines, enough to see through the next several months, when infections will have died.

Tens of patients queue up for medicines at the rural hospital’s pharmacy. Some of them are waiting to be admitted, but there’s no space.

But why small infections are proving fatal? The health machinery is still studying the cases and the pattern of flu. Rural doctors say poor nutrition and a declining immunity is turning peasants and labourers vulnerable to viral fever.

“Most patients have poor nutrition standards,” says Dr Poddar. “Viral fever can’t be so deadly, but if the patients’ immune system is weak it could become fatal.” This year, he says, many of those who fell sick worked in double shifts. Demand for farm hands spiraled with pest and weed infestations due to incessant rains.

What has foxed the health machinery is that all 45 deaths are of adults. Children along with pregnant women are among the risk groups.

Neither the government hospitals nor the private ones record patients’ weight, a key to calculate the body mass index that could give significant insight into their nutrition standards. But as Dr Poddar suggests rural adults are eating lesser.

In Surali, Dr Fate agrees. “I see a constant decline in nutrition standards among the villagers, particularly women,” he says. “I have never seen such an outbreak in this part in the 20 years of my practice,” he says. “Most patients come late to us,” he says. They’ll try home remedies; then take analgesics, and when nothing works, come to them, he says. “Most of them pay no heed to their fever because their farms need more attention.” Like Nirmalabai, who says, she had fever for a fortnight, but she had no time to see a doctor, until she collapsed two days ago.

Fever, fear, plague Amravati

September 17:

An outbreak of viral fever, including the swine flu, has claimed in a month about 35 lives at Warud, an orange producing belt hundred km from here in Amravati district.

Seven of these deaths have occurred in 24 hours, rattling the sluggish rural health system grappling with a heavy rush of patients and acute medicine shortage rooted in recent policy changes.

At least eight deaths, health officials confirm, are due to Type A-H1N1 virus or swine flu, which the World Health Organization (WHO) says is in its post-pandemic period. Significantly most of the deceased are adults.

“There is always a brisk flow of patients during this season,” Dr Pramod Poddar, who heads the Warud rural hospital, said. “But this year due to a combination of factors, the mortality has shot up.”

The 30-bed rural hospital is thrown out of gear, with a sudden increase in its Out Patient Department. “We are operating a daily OPD of 400-500 patients,” Dr Poddar said. The scene at the private clinics is no different. Late diagnosis in some cases, where patients came late to the hospital in the advance stage of fever with adult respiratory distress syndrome (ARDS), resulted in some deaths, he said.

Heavy rains this year have triggered outbreaks of viral fever and water-borne illnesses across Vidarbha. More than 25 patients admitted from various parts of the central India, including neighbouring districts of Madhya Pradesh and Chhattisgarh, the government medical college and hospital (GMCH) at Nagpur have died of swine flu since the beginning of monsoon, authorities said. But Warud is the latest hotspot.

The outbreak of viral fever is compounded by a severe paucity of medicines, local MLA Dr Anil Bonde, an MD in Medicine himself, said. “The situation was avoidable,” he said.

The medicine crunch reported at the rural hospitals and primary health centers in at least 14 districts in Maharashtra has arisen out of the changes in drug purchase rules earlier this year.

The government terminated its earlier decentralized purchase policy citing corruption, but did not place orders for procurement of the essential drugs in the past four months, pushing the PHCs and rural hospitals into a state of coma.

“The rural hospital did not have even Paracetamol (the commonly available anti-pyretic analgesic,” Dr Bonde said. “We had to provide all the essential drugs from the funds we raised,” he said.

Officials said they had been begging for medicine supply in view of the steady increase in the number of patients this year particularly due to heavy rains. “In some cases, paucity of medicines was fatal.”

The health minister, Suresh Shetty, had reportedly instructed the chief surgeon of Amravati to go for local procurement of medicines. The chief surgeon denies having any written orders for local purchase. The district collector was instructed to release Rs 20 lakh from the district plan for the health exigency. But sources in the know at Amravati said it took him a month to get the technical clearance.

Even as the rural patients continued to pour in, the union of Warud journalists ran a campaign to raise collections and self-contributed to that fund. A few days ago, the district guardian minister Rajendra Darda, who holds the industries portfolio in the Ashok Chavan-cabinet, visited Warud and promised help but the structural problems have not yet been fixed, health authorities said.

The medicines to the rural hospital are being bought from the Rs 3.5 lakh collected from the people of Warud and public representatives, local MLA, Dr Anil Bonde, said. An MD in medicine himself, Dr Bonde said the fund is also supporting the ambulance service.