Wednesday, August 5, 2009

Novel H1N1 flu death in Pune.'Angel' Ministers and 'Villain' doctors

The tragedy of death of 14 year old girl in Pune,India's first death due to H1N1 flu['swine' flu] has created a media frenzy among our news hungry 24/7 tv channels.

The girl reported symptoms of sore throat, runny nose, headaches on July 21 and consulted a general practitioner. Since the symptoms improved, she attended school. But the fever returned and she was admitted to the Jehangir Hospital on July 27. Incidentally, the girl was admitted for treatment of suspected pneumonia.Her lung aspirate was sent to the National Institute of Virology on July 31 and she tested positive for swine flu. She had been put on Oseltamivir on July 30.“She had vague and non-specific symptoms,” Dr Prasad Muglikar, Medical Superintendent, Jehangir Hospital told The Indian Express. “After admission, her condition deteriorated rapidly and she had to be put on a ventilator. As part of investigations, we sent samples to the NIV. They confirmed she was infected with the H1N1 virus,” he said, pointing out “she had already visited two private practitioners and was in a breathless state when she was admitted on July 27.”

Who is to blame? That is the first question all news anchors and reporters are asking.The answer I thought is obvious. H1N1 virus must be the culprit. But the answers I heard was entirely different.
See these reports.
Terming the death of a swine-flu infected girl in Pune as "unfortunate", Maharashtra Chief Minister Ashok Chavan has said negligence on part of the private hospital which treated the 14-year-old was to blame for it."This incident is really unfortunate. I feel there was total negligence on part of those who admitted her to the hospital and negligence on part of the hospital,"

The life of the swine-flu affected teenaged girl in Pune could have been saved had she tested positive for the virus and taken Tamiflu, a drug against the disease, on time, the Health Minister said on Monday night.Union Health Minister Ghulam Nabi Azad said the girl had first gone to a private hospital who treated her for "normal flu".When she did not recover, she got herself admitted to another private hospital where again she was treated not for H1N1 but for pneumonia, he said."So, after having treated her for two days, the private hospital realized that there is some more than pneumonia. But by that time, both her lungs were involved," the minister said.By the time, she was detected with the disease and given the medicine, "it was too late"."I feel that had she got the test done right in the beginning, it would have come out positive and then should would have been administered Tamiflu and her life could have been saved," Azad told NDTV.

These are not expert doctors talking. The Chief Minister and the Union Health Minister's statements had not come after an enquiry by an expert panel. They must have asked their local Party men and must have got information from them that it is better to blame the doctors and the hospital. That is the sorry state of affairs in India.

As of 31st July the World Health Organisation has reported 1154 confirmed deaths due to H1N1 flu out of 162380 confirmed cases. Highest number of deaths, 302 is from the United States of America and Mexico with 141 deaths comes second.Were all these deaths due to negligence of doctors?

Brazil had its first death due to H1N1 flu in late June.See how the health minister reacted there.
Brazil had its first death from the H1N1 influenza, or swine flu, on Sunday, after a 29-year-old man succumbed to the virus which he picked up in Argentina, Health Minister Jose Gomes Temporao said.He first showed symptoms on June 15 while on a trip to Argentina, which has had several deaths due to the flu. After returning to Brazil on June 19, he was admitted to a hospital the following day where he was confirmed to have the H1N1 virus.The ministry has in recent days warned Brazilians against traveling to Argentina and Chile. It also said the total confirmed cases of the deadly flu had reached 627 in Brazil.Officials expect further deaths as the virus spreads during the coming winter months, which began a week ago in Brazil.

All the Health authorities in the World have reacted in a sober manner like this except India. No Indian media reporter was smart enough to ask the Indian Health Minister on basis of what expert report he is commenting that the doctors are to blame.

In India most of the studies have shown that about 70 percent of people approach privately owned health care facilities for all their needs. Why is it so?
Among the countries of the World, Indian Government spend the least for Health. It is always around 1 percent of the GDP while most other countries spend between 5 to 10 percent of the GDP.That is why our ill-equipped Government run health care facilities are equally shunned by patients, doctors and politicians.
Instead of blaming with out any scientific or rational basis the doctors who treated the girl, will our politicians and Health policy makers try to revamp the tottering Health Care system?


  1. Our politicians love playing the blame game because it allows them to score brownie points and cover up their faults...Nothing ever changes in India...

  2. ***sigh** We indians are smart in politizing stuff,no matter even if it the death of a girl..

    Its scary that unknown epidemics are eating us out...

  3. What a fresh perspective from the rhetoric being served out in the media.

    I don't know whether there was negligence on the doctor's part..but ministers should learn to shut up and get their facts before crying hoarse.

  4. As the truism goes "Politicians are like diapers -- always full of crap. If not, it is just a matter of time".

    Our netas are a shade worse and do not loose much of an opportunity to thrust themselves into the limelight even in the most tragic of situations. Hence where we are and hence the distrust in anything Government run ...

  5. I agree with what this post is trying to convey about Indian Politicians 'politicising' any damn thing that they hear or come across.

    I have a feeling that this post is also trying to convey that there was no 'negligence' and a death or two is normal in swine flu which I don't agree with.

    The lax attitude with which the country is treating this epidemic comes out here.Let me share with you how Singapore is going about handling it (And I bet you will agree that its not the money that you need here, its the attitude) :-

    1)If you are visiting a clinic ( any damn clinic be it a skin clinic ) you have to fill up a small form outside the clinic where you have to declare if you have any 'flu like' symptoms or if you are 'feverish'. Then there is an mask protected attendant who checks your temperature.
    If you don't have any fever, or flu like symptoms, you are freely allowed inside, whereas if you have either of those, you can wear a mask and see a doctor.

    2)The doctor tests you, and if he/she confirms that you might have a flu or if you have just travelled from outside, an ambulance is called in and you are escorted to the hospital where you are tested for swine flu.

    3)If you test positive, Ofcourse you are quarantined.

    As much as i know, these are the basic steps being taken here.We do have a lot of H1N1 cases but no deaths so far.

    Simple steps, right?But do you see the difference in attitude?

    Now I understand if a person in India doesn't even see a doctor either because of the laid back attitude or because of financial conditions and then die,but I think this gal visited private clinics twice before she was admitted into the hospital. Also - After she was admitted her blood samples were not sent to NIV initially and were sent to RUBY which tested her samples as 'negative'. This is a definite negligence and the hospital should indeed be sued.

    However every problem in India is much bigger than it looks and has its root in the lax action coming from the top - the Govt.

  6. Bones,
    Politicians had their own neck to save.So they will pass on the blame.But the media persons who interviewed the Ministers did not question the Minister on basis of which enquiry he is blaming the hospital concerned.

  7. nimmy, Ministers statements obviously resulted in loss of public confidence in pvt doctors and hospitals.It also resulted in loss of confidence among pvt doctors in treating flu.That resulted in stampede of flu patients in front of Govt Hospital which in turn will ensure that even without H1N1 flu will get it from someone in the crowd.

  8. Layman, when a tragedy happens the first thing you should think about is how to prevent further tragedies.Enquiries and blame games can wait. The ministers statements will directly increase the chance of further spreading of infection as I described in above comment and a furhter heavy work load on tottering public health system as most pvt hospitals will shunt all flu patients to Govt sector.

  9. Madhu Rao welcome to this blog.

    Political interference is one of the major reason for inefficiency in public hospitals.That was my experience while working there.

  10. Chikki, welcome back and always love to see your straight talk.
    Politicising may not be the correct word. Trying to blame someone else so that their skin can be saved, that is what happened but with expectedly disastrous consequences. The scene of stampede and fight between parents of children with 'flu' in front of the Govt health facility was shocking.
    I am not sure whether there was medical negligence or not. If you are sure there was negligence then you can publicly say that, as you are not a part of the Govt.But before someone from the Govt says that it should be based on some enquiry. Let the law takes its own course.
    I had read about the wonderful health care system of Singapore. It is not only of high quality but also very cost efficient as there they have achieved much better health standards than most other developed countries but by spending only 3.5% of GDP whereas USA spends almost 16%. There are lots of lessons to be learned by India from Singapore even though such successes may not be that easily replicated here.
    By August 6, 2009, there has been EIGHT deaths of H1N1 positive patients in Singapore.The last death occured few hours ago. Read about it here The fact that you living there is not aware of that fact confirms my theory that everywhere else these matters are dealt in a sober manner by all concerned including the media unlike India.

  11. Hi - Yes! I can't believe I thought there were no deaths in Singapore with Channel news Asia's feed coming to my homepage. Yea - there was certainly no hue and cry here.

    When I used the word 'politicising', I did stop for a moment, but I concluded this blame game is a part of 'politicising', so I used the broader word 'politicising'.

    About the law - Just read about it - Its about 112 years old - epidemic Act i.e. This is what happens if your lawmakers work about 100 days in a year of 365 days.Disgusting!

    Yups - I don't have an enquiry report in my hand, from what we know it does look like hospital is to blame. The bigger picture however is the lack of directives from the ministry to the hospitals in how to tackle the crisis for which the Govt is to blame for sure.

  12. Politicos are always there to make matters worse, and being a healthcare professional I understand only too well how the system works against the people working at ground doctors and nurses. If you're a Govt Hospital doc then less said the better.

  13. Chikki, by Law I meant the criminal and civil law not the epidemic control law.

    I agree that lack of clear directive from the Central health authorities contributed to the confusion.

    There has been another death of an H1N1 positive patient today and soon there will be many more and the news value will reduce.The health care system will surely be severely tested.

  14. I completely agree Scorpiogenius.
    Let us compare this with terrorist strike in Mumbai last year.
    If the Home Minister began similar accusation on the Police immediately after 26/11 occured before any enquiry how will it affect the morale of the Police Force? How will it affect the public confidence in security forces?

  15. I am intrigued how anti-capitalism brigade missed this:

    The Swine Flu is corporate America's contribution to the world (check the two links below).

    Moreover, by not screening outgoing passengers, America failed to prevent its spread to other parts of the world. No government had the gall to ask it to.


  16. Charakan no doubt about the politicians always looking for someone to blame and also to get some mileage... but since Swine flu is in the news, I think it should have been kept in mind by thehospital. Also the government could make sure the doctors all over the country are provided information about the flu, since it is caused by a new virus.

    My daughter had some fever and viral like symptoms last month, and I had asked our doctor (in Delhi) if she had Swine Flu - now although his prescription did make her better exactly in three days as predicted by him, I would have been more at peace if he could have described exactly what Swine Flu symptoms were... now it seems the symptoms are too general, just like many other seasonal 'viral fevers'...

    Blaming the doctors also is a result of ignorance I think. Today CNN IBN has got some doctors on TV speaking about what to watch out for, and what precautions to take.

  17. What you are saying is so true. Here in the UK, there have been 41 deaths, but they have gone out to ensure that people are aware that there have been underlying health issues that played an important factor. Only in India, can we see uninformed leaders trying to blame somebody and gaining political mileage.. As you said, what India needs is information, precautionary measures that can be taken, etc instead of sensationalization..

  18. IHM, The behaviour of the Union Health Minister Mr Azad has been remarkably stupid and dangerous during these early days of this novel H1N1 flu epidemic.
    The virus is new and nobody really can predict its behaviour. When introduced into a community for the first time it usually is more virulent[strong] and causes more damage. Slowly the immunity level in the community increases and the virus become less harmful.
    Symptoms of novel HINI is same as other influenza. When the patient is becoming more sick the test should be done.

  19. Smitha, Now with 10 deaths and many more to come Indian health care system is about to face a tough time.
    Minister will no longer be able blame the doctors.
    A Govt who spends least on health in the World will find it difficult to cope with this epidemic. May be the only hope is with so much different type of pathogens in circulation in India H1N1 will get sidelined by other viruses and bacterias.

  20. Yes Charakan I agree. Yesterday I watched one minister claiming that America has more deaths and worse condition than we do... Arnav Bhattacharya asked him, and rightly too, why was America a criteria???


Comments are welcome especially if you do not think like me. But anonymous comments behind masks and those not relevant to the post are not encouraged.