India's health workers rise to the occasion

Abstract

Rapid mobilisation of health ministry machinery helps India refute criticisms of bureaucracy The biggest challenge confronting India's health establishment after the tsunamis is ensuring that efforts to prevent epidemics in the affected States of Tamil Nadu, Andhra Pradesh, Kerala, Pondicherry, and the Andaman and Nicobar Islands do not slacken. “Right now, all our efforts are directed towards sustaining disease surveillance. The greatest danger at this point is complacency”, says Supriya Sahu, a senior health official in Tamil Nadu. An integrated disease surveillance project cell, supported by WHO, will soon start to collect daily reports of communicable diseases from all primary health centres in Nagapattinam, one of the three worst-affected districts in the state. As the government's focus shifts from relief to rehabilitation, and the number of people returning to their villages continues to rise, health officials say the top priorities are provision of safe drinking water, proper disposal of excreta, digging trench latrines, improvement of personal hygiene, prevention of waterborne and vector-borne diseases, psychosocial rehabilitation, and restoration of damaged infrastructure. “UNICEF is helping us with supplies of chlorine tablets, bleaching powder, and also with construction of temporary toilets and water tanks”, notes Tamil Nadu health official Sahu. Cuddalore has received 30 chloroscopes from WHO for monitoring residual chlorine in drinking water supplies at camps. Water and food samples are being tested for pathogens. WHO has also supplied 2500 insecticide-impregnated mosquito bednets for distribution to affected families in the Nagapattinam district. India, which initially declined foreign help for its tsunami survivors, has allowed UNICEF to help mount a campaign in the Andaman and Nicobar islands to prevent measles and blindness among children. Most of the relief and rehabilitation work in the federally-administered islands is being undertaken by the Indian military, alongside government public-health specialists. Detailed information is still awaited, but according to preliminary assessments, the damage to health infrastructure in the affected areas in India is less severe than in other tsunami-hit countries. “In all, 26 primary health centres, 79 sub-centres, and six district hospitals in Kerala, Tamil Nadu, and the A&N Islands have been partially or fully damaged”, says Emergency Medical Relief Director Ravindran He says damage to these health facilities has not affected services because other centres can compensate for the loss. “There are very few tsunami-related injuries in the hospitals currently and septicaemia has not been a problem due to adequate medical care”, adds Ravindran. Immediately after the disaster struck, the government mobilised public-health specialists, psychiatrists, and medical officers from various parts of the country and, as of mid January, central medical teams had attended to nearly 30 000 patients. Teams from the Bangalore-based National Institute of Mental Health and Neuroscience, provided counselling services at relief camps in Port Blair, the capital of Andaman, to over 1000 individuals classed as severely disturbed. In India, the largest and most diverse of the affected countries, the tragedy has brought an outpouring of private contributions of money and labour from all regions and sectors. Private medical practioners in India have supported government doctors in most of the affected areas. V Kumar, Tamil Nadu coordinator of the Indian Medical Association, says within days of the tsunami, 167 branches of the IMA's Tamil Nadu division were activated and doctors and paramedical staff from surrounding states had rushed in to help. The injured were referred to nearby medical colleges and private hospitals and clinics where they were treated free of cost. In Cuddalore, routine deliveries continued even amid the crisis. “We set up temporary wards wherever necessary to attend to the injured and to treat routine medical care cases”, says S Narainswamy, resident medical officer of the government hospital in Cuddalore district. The tsunami has brought to the fore a less visible side of India's much-maligned health-care system. The crisis managers in the health ministry mobilised several networks from within the government and its success in averting epidemics until now is largely due to the collaborative spirit in which government and private doctors have worked. As normal life begins to resume, more issues are coming to the fore. Doctors are now hoping that the energy and dedication so visible in the hour of crisis are tapped to tackle the long-term task of rebuilding lives.