Letters 35
Letter from Chennai
THE MARIE ANTOINETTE SYNDROME
Rousseau, in his Confessions, tells of a princess
who, on being informed that the country people had no bread,
replied, ‘Let them eat cake.’ This statement is generally
attributed to Marie Antoinette, though there is no evidence
that it ever passed her lips.
During the monsoon, our roads are converted into rivers.
Our drains never seem to work. With every monsoon, water comes
bubbling out of the storm water drains like a geyser from an
underground spring, and brings sewage with it. Leptospirosis
abounds. That is not all. Each time our roads are re-laid a
layer of bitumen is spread on top of the road and then rolled
in place. The level of the road rises by 3 inches. In my young
days, each time a road was repaired, it was dug up to some
depth and the foundations of the road were replaced with small
stones, which we called road metal. Thus treated, the road
level remained the same, and it used to last 12 years. Now it
lasts only one monsoon, and a fresh surface coat is applied.
The road keeps rising, and our houses and gardens sink below
the road level. When the road is flooded, our gardens are too,
and during a heavy and sustained downpour sewage-laden water
enters our homes. Why in these days of improved technology our
engineers cannot make a road last more than one heavy rain
defies reason. Many citizens suspect the poor survival of
roads is not from technical but from economic causes. This is
planned obsolescence. Someone must have an interest in annual
re-laying of the roads, and it is certainly not we the people.
The government informed us that there would be no fear of
flooding in 2006. Marooned on the first floor of my house,
with water flowing through the ground floor, I was not
reassured. And if I have convinced you that I have troubles,
imagine the plight of hutment dwellers, whose entire
possessions are washed away every year.
The water spouting from the underground drains poses yet
another hazard. It often lifts the manhole cover and moves it
aside. We now have an open manhole concealed by a stream of
muddy water flowing over it. Unwary souls wading through the
water on the road could easily fall into these traps. Children
have been known to drown there, and even adults may suffer
serious and badly infected injuries.
We have many subways where the road dives under the railway
line. ‘Dives’ is the right word. Excellence in engineering
does not extend to ensuring that the subway stays reasonably
dry in the monsoon. Water collects there, even in the newest
of our subways that was opened only a few weeks ago. What we
need is a ferry service to take us across the subway. Modern
cars, especially those with electrically operated windows and
automatic remote locking of doors, pose a new hazard. Mumbai
faced the problem during its horrendous rains in 2005, and we
had our first experience in 2006. Three people died trapped in
a car whose doors and windows they were apparently unable to
open.
The conditions are ideal for mosquitoes. Tamilians are
dying of malaria and dengue, or are crippled by chikungunya.
There has been an increase in cerebral malaria. How can we
consider ourselves leaders in technology if we cannot curb the
breeding of mosquitoes, if flooding is an annual problem, if
year after year slum dwellers see their homes washed away? One
would think the government would devote every resource to
control this problem. Instead, we experience the Marie
Antoinette syndrome. We are told that 2.5 million TV sets will
be distributed to the poor. When someone commented that they
could not afford to pay for the electricity or for cable
channels, our chief minister most philanthropically said he
would provide both free of cost. If they cannot keep dry and
healthy, let them watch TV when they are confined to bed with
fever.
Is this proper use of public funds? Should entertainment
take priority over good health? Yet the promise of TV sets was
a significant factor in our last election. The people get the
government they deserve.
SCHOOL HEALTH CHECK
Compulsory schooling offers a great opportunity to improve
the health of the nation. A simple set of tests would enable
us to detect disease in the young, and treat it at the
outset. One does not have to go house to house in search of
subjects. The New Indian Express of Chennai revealed
that the medical officers of the Corporation had not checked
students in Corporation schools for years. This is one news
item that had a beneficial effect. The Additional
Commissioner (Health) of the Corporation, in response to
this news item, admitted the truth of the report, but said
he would immediately take steps to re-introduce the health
check-up.
THE CONDOM INDEX
The Tamil Nadu State AIDS Control Society (TNSACS) was formed
in 1994 with the Secretary for Health as the president and a
senior IAS officer as the project director. This has been a
successful application of public–private cooperation. A number
of non-governmental organizations (NGOs) have been associated
with the work, and some 200 receive financial support from
TNSACS. Some of the NGOs are involved in planning and
implementing intervention programmes, and others are
organizations of people living with HIV/AIDS (PLHA). A key
component of the work is distribution of condoms with the help
of NGOs.
Chennai’s sales figures for condoms over the past few years
have risen from 3.3 million in 2003–04 to 6.8 million in
2004–05, soaring to 12.9 million in 2005–06. Condoms are
available in many new locations, fair price shops, bus stands
and railway stations, movie theatres and petrol bunks, and
through 480 condom vending machines all over the city. An
official of TNSACS attributed the rise to increased awareness
of HIV and the role of condoms in preventing its spread. A
study by ORG–MARG reports an increase in awareness of HIV–AIDS
in the general public from 23% in 1992 to 96.2% in 1997—98.2%
in urban and 94.4% in rural areas. These figures seem too good
to be true, but the rise in condom sales does indicate this
trend.
FAMILY PLANNING
Whatever happened to the family planning programme? One point
seems clear: it is the women who are keen and actively for it.
Dr K. Manivasan, Additional Commissioner in the Health
Department of the Chennai Corporation, announced the other day
that just 56 vasectomies were done under the aegis of the
Corporation in 2005 against 14 000 tubal ligations. When you
consider that it is so much easier to perform a vasectomy than
it is to ligate the tubes, these figures are surprising. But
then we have to admit we are a male chauvinist society and,
since women have to bear the brunt of the extra burden of
rearing children, they are more interested in restricting
their families.
RURAL HEALTH INSURANCE
Karnataka has been among the leaders in this field. Dr H.
Sudarshan and his Karuna Health Trust initiated a simple
health insurance scheme for people below the poverty line.
They pay an annual premium of Rs 30. This ensures that they
will receive Rs 50 per day as compensation for lost wages if
they need hospitalization, for a maximum of 25 days. This
covers admission only to Primary Health Centres and other
government hospitals. If they are admitted to a hospital, they
are also allowed to purchase medicines for up to Rs 50 per
day, which are not stocked in the hospital.
The government followed suit with the Yashasvini Scheme, in
which a premium of Rs 120 per year allows the patient to have
surgical attention at any one of a number of participating
hospitals, to a maximum expenditure of Rs 100 000. The average
occupancy of hospitals in Karnataka was worked out to be just
35%, so there is an incentive for the hospitals to take part.
As for the subscribers, their numbers indicate that they
welcome the scheme—170 000 registered during 2004–05, 250 000
during 2005–06, and drew 170 000 in the first 9 months of
2006–07. The famous cardiothoracic surgeon, Dr Devi Shetty of
the Narayana Hrudayalaya, is intimately associated with the
scheme.
I do not know whether this will prove an economically
viable proposition. It is an Indian trait to misuse any
beneficial scheme, and thereby to kill the goose that lays the
golden eggs. Insurance is often taken when a person knows he
is ill and needs treatment, and he then strenuously tries to
conceal a pre-existing condition. One hopes the relatively
unsophisticated villager will not learn these tricks. If the
scheme proves a financial disaster, it cannot be sustained.
Meanwhile, the Government of Andhra Pradesh has decided to
introduce a similar scheme for people living below the poverty
line. The premium will be Rs 100 per annum for an individual,
Rs 300 for a family. The scheme covers cardiac, neurological
and renal diseases, and cancer. Insured persons who develop
any of these illnesses will be treated at government hospitals
and participating private hospitals, with Rs 200 000 being the
upper limit of cover. If expenses exceed this figure, the
private hospital or the government will have to meet the
shortfall. This will be a public–private partnership, with the
state, insurance companies and hospitals involved. I hope it
will work.
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