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Saturday, August 14, 2004

While the Kumbakonam tragedy is yet to fade away from our memory, the heartrending saga of kids with heart aliments has come to stalk our collective conscience. Hundreds of paediatric cardiac patients were paraded on the streets of Hyderabad seeking surgical treatment, and one of them died in front of television cameras. The well-meaning media and activists are focusing on the human drama and pathos and pressurizing the government to make allocations. Hospitals are hard-put to cope with the patient-load. In all this, the real issues are ignored to the detriment of the poor. As a sage said, “ God, I will deal with my enemies on my own; but save me from my friends!”

A few facts first. Congenital (CHD) and rheumatic heart diseases (RHD) are the two major forms of heart disease afflicting the young. On an average, eight children out of 1000 are born with CHD. And the commonest causes of CHD are fully preventable maternal infections during pregnancy, consanguineous marriages, and childbearing by women above 30 years of age. All these are completely avoidable – by MMR vaccination, marriage counseling, and public education on risks of marrying relatives and late childbearing. And yet, annually about 200,000 children are born with CHD in India. The case of RHD is even more pathetic. It is caused by a simple streptococcal sore throat, a common childhood infection, between the ages of 5 and 15. While sore throat is gone in a couple of days, the child may develop Rheumatic fever, resulting in RHD. Even most educated middle-class parents are unaware of this. RHD is fully preventable, and all it needs is immediate treatment of strepthroat in children with simple, relatively inexpensive, antibiotics. And yet, over 150,000 children get RHD every year. There are probably 5 to 10 million Indians suffering from CHD and RH

Now let us look at our health infrastructure and need for allocations to meet this challenge after the disease strikes children. In the entire country, a total of 42,000 heart surgeries take place. A typical surgery costs Rs 100,000. 90% of these surgeries are for coronary artery disease, and not even 10% on CHD and RHD. If today’s government is willing to make allocations to surgically treat all cases of CHD and RHD – it will have to allocate Rs 50,000 crores to just take care of the existing patients – and at the current rate it will take over a 1000 years!  It would cost Rs 4000 crores to take care of the 350,000 new patients who are added each year. Even after all that expense and effort, about half the patients cannot be helped much and the life span of the rest is prolonged for only limited periods. Meanwhile human misery keeps mounting as more unborn, and young children are afflicted by these preventable diseases.

Clearly, misplaced compassion and political grandstanding are no substitutes to sensible policy when it comes to promoting human welfare. What we need is a campaign of mass immunization (MMR), public education (consanguineous marriages, late pregnancies and strepthroat), and immediate treatment of strepthroat in all children in 5 – 15 age group. Such a programme costs no more than Rs.100 crores per annum for the whole country. Many diseases can be tackled through an effective delivery system to spread health education, administer vaccines and early treatment. For this, an army of million health volunteers needs to be raised at a low cost (about Rs. 600 crores per annum) to be the interface between the community and primary health centres, and they will address all the health needs, including heart diseases. We definitely need to help the unfortunate victims of CHD and RHD with available resources, but the priority should be clearly to prevent millions from becoming victims tomorrow. Let us not make the same mistake we made in the initial stages of fighting Polio – through our misplaced compassion and not so sensible policies, governments spent scarce money on calipers for Polio victims instead of focusing on immunization. The near eradication of Polio now has proved that we are capable of overcoming our mistakes and taking on such successful campaigns.

We are lucky to live in an age when most problems have simple, effective, relatively low-cost, high-impact solutions. Very few of our problems are intractable. A bit of wisdom, sensible policies, well-directed and modest allocations, and effective delivery systems can accomplish a great deal to promote growth and human happiness.