Goa's Pathetic Public Health System

Nandkumar Kamat
 

It is another world health day. This year, the theme urges us to create a healthy environment for the children. It is an excellent theme because Goa has surpassed the national targets for low infant mortality. In the immunisation programme, Goa is second to none. Many such health indicators are routinely flashed by the government to silence the genuine critics of Goa's public health system.  But that is a packaged official version. The public health system is stressed by infrastructural neglect, low quality of manpower, lack of efficient supervision and co-ordination and needs a thorough professional overhauling. There are several areas of contradiction.

Nobody is sure about the implementation status of the ambitious Public Health Act, 1985, which was a model piece of legislation. It had given biting teeth to the public health machinery in all the affairs of public health management. A copy of this Act is rarer to find than the copy of the first book printed in Goa. Forceful, consistent, appropriate implementation of this Act would have made Goa a much better, cleaner and healthier place today.

Let us take the example of the children born, living and growing in a typical urban environment of Goa. Every infant is subjected to a bombardment of air pollution.  Main pollutants are in the form of suspended particles and exhaust gases.

Goan farmers take tremendous pleasure in burning the agricultural residues in open fields instead of composting this recyclable biomass. All over Goa agro-waste burning is heavily contributing to high levels of dangerous aerosols. These are trapped with cold air when thermal inversion takes place. Add to this smoke and the aerosol, the exhaust gases and combustion products of vehicles. We could then witness frequent episodes of smog in and around the cities. The smog carries a peculiar, faint acrid, organic smell.

The air pollution has been impacting the health of Goa's children. Panjim is more enthusiastic about conservation of built heritage but there is very little concern about the city's deteriorating air quality.

A medical prescription survey of Panjim's pharmacies would showthe increasing levels of respiratory illnesses and higher quantities of medicines consumed by people. I frequently come across taxi drivers who do not smoke but still have a peculiar, persistent dry cough. Obviously, there is something in the air which they breathe. This is not a healthy trend in a state which claims to be healthy.

Children suffer the most from the air, water and noise pollution. The chlorinated tap water supplied by the government may not pass the quality specifications. In areas where the taps go dry, the children are given untreated water. Sometimes it is loaded with bleaching powder. In many villages, children still consume dirty water from dry river beds, lakes, fountains or untreated wells.

Boiling dirty water does not destroy everything. Clean, filtered water free from man-made chemical residues and pathogens brings down the disease load. If all the children in Goa are supplied clean drinking water then it would change the morbidity spectrum.  In the 70s and 80s, children from Pirna, Nadoda and other villages used to succumb to gastro-intestinal diseases on account of consumption of pathogen loaded dirty water. In the 90s, with rural water supply scheme in these areas, the morbidity and mortality in the problem villages came down drastically. Thanks to relatively cleaner water.

The health secretary of Goa, Ms Rina Ray, is a dynamic and no-nonsense personality. She has taken keen interest to improve the Bal Niketan. She has several ideas to improve the image of public health sector of Goa.  But in the field what we actually experience and witness is shockingly different.  Most of
our public health facilities are badly managed and it is indeed a miracle that patients still flock to them. They are helpless because the private hospitals are expensive.

Every visit to the Goa Medical College hospital depresses me not because of the medical care but because of the ill-maintained wards, toilets, bathrooms, corridors,  and premises. Someone needs to give a thought to the landscaping of the hospital outdoors. The indoor conditions are deteriorating. I could see that there was no supervision of cleanliness in the inpatient wards of the hospital.

The VIP wards may be exceptions. Cobwebs have not been removed for weeks. Overhanging galleries are littered with debris. Staircases are sprayed with chewed tobacco.

When I had visited an accident victim admitted to the private ward after surgery, I could not believe the state of that room. The wall paint had been degraded by deadly fungi. The patient would have got cured from one illness but would carry home a hospital-borne sickness. It does not need a huge budget to maintain the cleanliness of Goa Medical College hospital. I shudder to think whether this hospital would be able to handle an outbreak of a major infectious epidemic disease in Goa.

None of Goa's public hospitals are well equipped to deal with major public health issues and emerging epidemics. The rural and urban health centres have their own sad story. Instead of building more such centers if the government pays attention to maintenance of existing facilities, then it would immensely help the health consumers. The village panchayats need to be involved in the management of rural health centres.

There are many surveys of Goa's public health sector. The NGO - Sangath had produced an excellent report titled 'The State of Health in Goa'. There is another report sponsored by UNICEF on children. And if one is interested in reading the official report on AIDS and HIV in Goa, it would frighten you. Extrapolation of 5.13 per cent seropositivity rate, which indicates prevalence of HIV among Goans could give an estimate of not less than 40,000 HIV carriers in the sexually fit population. This is a shocking number.

A true differential analysis of the disease load in Goa has not been done. The annual reports of the registrar of births and deaths present a disturbing profile of the public health sector of Goa. These reports classify the causes of death following an international classification system.

A careful scrutiny of these reports reveal the disturbing life-styled related health transition in Goa. The citizens are spoiling their health. Bad nutrition, work related stress and alcohol makes a deadly combination. The families are spoiling their children and teenagers. Folic acid, iron and Vitamin A deficiencies are prevalent. One-third of the neonates are born underweight. The figures of life expectancy hide the disease load in the population.

Several such issues could be highlighted but does anyone in the government care to address these honestly and professionally?


Dr. Nandkumar Kamat
April 7, 2003

This article  appeared in The Navhind Times, Goa

Materia Medica comment : This Nandkumar Kamat article outlines the tip of the mess aka the Public Health System of Goa.  It is important to note that this was NOT always so. The focal point of health care delivery in Goa is the Goa Medical College - which inherited and thus far maintained its excellent reputation as an excellent Medical School from the Escola Medica Cirurgica established by the the Portuguese in 1842. This was indeed the first Allopathic Medical School in Asia.

While Goa Medical College manages to dodge the destructive political machinations of the Politicians (including the political cabal which resides within the Faculty and Hospital Administration), the Hospitals can only be described as giant glorified slums.

What a shame !  The hospitals of the Escola Medica in 1961 (when the Portuguese were booted out by the Indian Army) were better than the  5 Star hotels of today!

It is quite apparent that in this State which produces some of the finest Medical Graduates in the country, it is the Corrupt, Callous, Sick, Tired and Decrepit  Health Care system which is in need of urgent attention.

But......let not anybody hold their breath for that to happen!  The cabal is more busy playing Politricks!

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