Fighting disease

How I survived swine flu and Delhi’s poor public health system

The lack of information on how to access the government-prescribed drug for H1N1 is making the infection deadlier.

If you live in Delhi, have swine flu and are prescribed the recommended anti-viral drug, do you know where you can buy it?

When my swine flu (H1N1) test from a government-authorised private pathology lab returned positive, my doctor prescribed Fluvir, a drug manufactured by Hetero Drugs and approved by the government as the anti-viral treatment for swine flu. The good doctor checked with the pharmacy at the major hospital where he consults and came up empty-handed. In his gentle, kindly way he told me that it was important to start the medication as soon as possible and that my best bet for getting hold of Fluvir was to ask someone with influence in the government.

Never having done this before, and having failed to find any information on the internet (websites of Union Health Ministry, Delhi government’s Department of Health, and all major government hospitals), I asked a resourceful journalist friend if there was a list of chemists that stocked the drug. There was none she could find.

I then called a usually well-stocked pharmacy. It was not “authorised” to stock Fluvir, but could suggest the names of a couple of others that might be. I called both. The first said it did not have the drug in stock. The second said I needed a test report from a government laboratory. Neither knew of another pharmacy authorised to stock the drug.

So with the fever rising, a call was finally made to someone who might know someone who could traverse the maze of Delhi’s government medical establishment. Even this took a little doing. It was possible, our someone was told, that perhaps I did not really need the medication; in any case, I should have gone to a government hospital to be examined. But since our someone was really someone, they would do us a favour this time. Messages were sent down the line, paperwork created and the drug procured.

‘We are here for people’

A week later, much recovered, not in small measure because I had started the medicine in time, I began to wonder how it all worked. So I called Dr Charan Singh, Additional Director Public Health, and the go-to man on swine flu for journalists. I asked him what the best method of procuring Fluvir was with a H1N1 positive test report and a doctor’s prescription.

He said, “Once the test is positive, they will be given the medicine.” I explained that this had not been my experience. He said, “Madam, if you had just called me, I would have immediately given you the medicine.” I asked him, “What should an average resident of Delhi who is not a journalist do?” He said, “Anyone can call me, we are here for people only. I will give them medicine.” Had the government advertised this fact, made available all the information, including his location and phone number? He said, “They will put an advertisement next week.”

After several similar conversations with Dr Singh, doctors in the casualty departments of Ram Manohar Lohia Hospital and staff in the casualty, pathology and microbiology departments of the All India Institute for Medical Sciences, this is what I learnt:

If you go to a government hospital’s casualty department as an outpatient and test positive for swine flu or fit the description in the government guidelines for a patient who can be medicated without a test, you can buy Fluvir from an in-house pharmacy. Tests through government hospitals take 3-4 days. If you are a “private sector patient”, you have a choice of five laboratories with multiple branches (tests cost as much as Rs 9,000 and are delivered in four hours). There are three privately-owned pharmacies authorised to sell Fluvir, and you have to take your chances on them having it in stock.

Incidence drops, fatalities rise

Swine flu, according to the Ministry of Health, is not as virulent today as it was in 2009. Yet government data for swine flu in India from 2009 to 2013 shows that while the reported incidence is far lower than it was in 2009, the proportion of deaths among those who tested positive for the virus is far higher. In 2009, when the government pulled out all the stops to test and treat swine flu, 3.6% of cases proved fatal. In the subsequent four years, this figure was between 8% and 13%. In 2009, there were 27,236 cases of the flu and 981 (3.6%) deaths. In 2013, there were 5,250 cases and 692 (over 13%) deaths.

In Delhi, there have been a total of 50 cases (tested positive) in the first 12 days of this year. Twenty nine were tested in private laboratories and 21 through government hospitals. There have also been four deaths. The numbers for the National Capital Region are higher but are disaggregated by state, so harder to get hold of. The Delhi deaths are in the age group of 30-45 years, an age span not normally regarded as “high risk” for swine flu. The government’s explanation is that these people had “underlying health problems”. So what are the underlying health problems to look out for? According to Dr Singh, “hypertension, diabetes, and other such things…”

Swine flu is certainly not a major killer. Cases of swine flu are also a fraction of total flu cases in a year. Yet it seems that lack of information and a public health culture that is slow, inefficient and overly controlling puts more people in hospital than is absolutely necessary. Apart from a few desultory news reports, the bulk of which are concerned with numbers of cases and casualties, there is no accessible information on what anyone should do if they have a cold and fever and suffering from swine flu.

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