Hepatitis C virus outbreak
was reported from a few villages of Kokernag, Anantnag more than two years ago
followed by an epidemic of cases and ongoing new cases in many neighbouring villages.
More than 800 cases are positive in just
two villages Takia Magam and Sonabarie.
Many deaths have been reported so far. Many
teams were dispatched to the area under media pressure to start with but as the
media’s interest dwindled, so did the attention of the authorities. The poor villagers have been abandoned without
any hope and are living with fear and stigma.
Some have sold their valuables
and land to get whatever treatment is available pushing them further into
poverty and ill health.
Unlike infections like
flu, where herd immunity breaks the transmission cycle, blood borne infections
like Hepatitis C will continue to spread until a source is identified. People can become infected with the
Hepatitis C virus by sharing needles, syringes, or other equipment to inject
drugs, needle stick injuries in health care settings, from mother to new born and
rarely by sharing personal care items such as razors or toothbrushes and having
sexual contact with a person infected with the Hepatitis C virus. As per
Centers for Disease Control and Prevention USA (CDC), of every 100 people
infected with the Hepatitis C virus, about 75–85 people will develop chronic
Hepatitis C virus infection; of those, 60–70 people will go on to develop
chronic liver disease, 5–20 people will go on to develop cirrhosis over a
period of 20–30 years and 1–5 people will die from cirrhosis or liver cancer.
Mind you this data is for developed countries with abundant resources and such
outbreaks are unheard of. In view of
lack of local research data, delay in treatment and poor health, the results
are likely to be much worse.
Although it has been
more than two years now, no one has been held accountable for the spread of
this infection. Various departments have
been pointing fingers at each other, trying to pass the buck. The fact is that this infection does not
spread unless there is direct inoculation into the body. Some of the local medical shops were held
responsible initially and closed down, but have been allowed to open again. It is ironic, that in spite of such huge
number of cases, the authorities have failed to commission a proper
investigation looking into the source and the way it is spreading. If the reason behind this out break is not
known, how will future cases be prevented?
Similar outbreaks have
been reported in other districts of the valley including the old city in
Srinagar. At least sixty people have been diagnosed with Hepatitis C in Wehal
hamlet of Shopian district in last few months.
In Kokernag itself, many more villages are affected; the actual number
of positive cases running much higher than the official stand. In village Sagam Kokernag, hundreds are
positive and the same is the case for other adjoining villages. People talk in whispers that ‘he or she has tested’
with mixed feelings of sympathy, shame and stigma. I was surprised to note one of my neighbours
on Aciloc tablet prescribed by a senior physician. She was reassured that she
is going to get better by her doctor. After initial disappointment I
appreciated the wisdom of this physician. He knew that this poor lady would not
be able to afford the actual treatment and telling her the truth would make her
life more miserable. These people have suffered physically as well as
emotionally. Some of them are being discriminated out of ignorance and at times
by the medical professionals fearing infection. No one has thought about
pregnant mothers and new born children.
The average cost of initial
treatment is about two lakh rupees which most of these poor villagers cannot
afford. There have been proposals from
the State to Centre for financial aid which has been declined. The previous
government had announced some package but that too has become the victim of
unending bureaucracy. Even if this money is released to the treat the current
cases, there is no plan for preventing the infection further. What about the
new cases coming up on daily basis? With delay in treatment many of them are going
to develop long term complications. Nothing has been said about managing and
helping such patients with chronic disease.
Even if local chemists
and self-styled dentists are spreading the infection, the onus of
responsibility still lies with the State. Firstly, why are they allowed to
operate and if they are really responsible, why are they still operating? These
untrained corner shops selling medicine are the first port of call for people
in far flung areas for obvious reasons. This brings us back to the question of
provision of primary health care on the ground. Let us be honest, the number of
primary health centres (PHC) is far less than the population needs. Even at
places having a PHC, dentistry has been left out in spite of having enough
unemployed dental surgeons in the state. I am not talking about having doctors
available everywhere, all the time, but the system needs to at least make sure
trained nurses or technicians are available so that people are not pushed to
quacks. I am not aware of any programmes of imparting regular training to
health professionals working in the department of health and medical education about
infection control. What is the guarantee
that this infection is not coming from places run by State, how often are the
sterilisation procedures audited? Testing
health workers for infections like HIV, Hep B and Hep C is mandatory around the
world but not here.
This brings the question
of responsibility and criminal negligence on the part of authorities. From various
news reports it seems that the department of health, local administration, drug
controller department, department of preventive and social medicine, SKIMS, Pharmacists
Association Anantnag have been blaming each other. The Draft Health Bill 2015 has proposed to
declare health as a fundamental right.
Article 21 of the Indian constitution declares right to life as a
fundamental right and State has a responsibility to safeguard its citizens.
Billions of rupees are spent on defence to protect the life of citizens. But
when the same citizens are under attack from a silent killer, the State becomes
a silent spectator, undermining the basic human right to life and health. There is enough case law to back this up. The
issue of adequacy of medical health services was addressed in Paschim Baga Khet
Mazoor Samiti Vs State of West Bengal.
The question before the court was whether the non-availability of
services in the government health centres amounted to a violation of Article
21. It was held that that Article 21
imposes an obligation on the State to safeguard the right to life of every
person. Preservation of human life is thus of paramount importance. Failure on part of a government hospital to
provide timely medical treatment, to a person in need of such treatment results
in violation of his right to life, guaranteed under Article 21. Therefore, the
failure of a government run health centre to provide timely treatment is
violative of a person’s right to life. It has also been held in this judgement
that the lack of financial resources cannot be a reason for the State to shy
away from its constitutional obligation.
Following public interest litigation (PIL)
last year, court was given assurances but nothing has been done since. Courts are the last resort to direct the authorities
to act and to charge the people or authorities responsible with criminal
negligence. The victims need to be compensated not only for treatment, but also
for the psychological trauma suffered by them and their families. The local
police must take cognisance and lodge an FIR for further investigations.
The health ministry
must clarify who is responsible for treating the current cases and also for
preventing further cases. Ruling party
PDP has been vocal about this issue when in opposition but it is time for them
to act now. If this type of outbreak had
happened in a responsible state, many heads would have rolled. The ex MLA Kokernag
failed to bring much relief to his voters.
The current MLA Kokernag Mr Abdul Rahim Rather has an uphill task to
safeguard the life and health of his constituents.
The departments of
microbiology and community medicine need to conduct robust epidemiological studies
so that the origin of infection and its spread is known. The department of Public Health (community
medicine) which is restricted to medical colleges needs to be expanded to
health department. Reporting of, and documenting all the positive
cases in a central register should be mandatory.
The Health department
should audit and review all the health facilities in the areas checking for any
contamination and source of infection. Health
workers need to be tested for their own safety and safety of others. Regular infection control training for all
the staff dealing with patients is also necessary. A long term strategy for controlling the spread
of this infection or similar infections across the state should be formulated
and made public.
Education will play a
big role in preventing further spread of the infection. Religious leaders, Imams and known elders can
be trained to spread the message in local communities. The department of
education could organise seminars and workshops in schools to make the younger
generation aware about such infections and its prevention.
The civil society too
must take this issue seriously like other cases of human rights. State human
rights commission needs to take account of the situation. Last but not least, people and members of
civil society must demand from their elected representatives their right to
safe, accountable and timely health care.
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