As Children Starve, Indian Hospital Inc. Gears Up to Serve The World


 

By Peter Pallot

Ties between Britain and India remain something of a wonder. While relations with some of Britain’s former colonies have grown weak, or disintegrated, the bond with the world’s biggest democracy flourishes. Perhaps it’s the cricket. Perhaps it’s the large Indian population in Britain, many of whom – doctors, nurses and others – keep the NHS afloat.

But how is health provision in the subcontinent?
“Mixed” is the kindest answer. For while India has skilfully promoted itself as a medical tourism centre, attracting patients from the Middle East, Africa and Europe, services for the majority of the billion-plus population are poor. The smart private hospitals are out of reach.
Only a quarter of the population can afford Western medicine, with the rest relying on traditional remedies or alternative treatments, such as acupuncture and Ayurvedic medicine (which can at least boast fewer adverse reactions).
Eighty-one per cent of health care across India is paid from private funds, mainly individual pockets. To compound the problem, the booming economy has attracted millions into the cities and away from the country’s rural network of hospitals.
According to the Organisation for Economic Co-operation and Development, in 2009 lower-income groups in India had less access to health care than 15 Asian countries surveyed, where, on average, only 55 per cent of health care is paid from private funds.

Infants at risk
India has come under criticism for not doing more to tackle the problem of infant deaths, the chief marker of the efficacy of a country’s health care system.
Unicef, the children’s charity, pointed out that of all deaths of children aged under one across the globe in 2008, a quarter occurred in India.
At 47 deaths per 1,000 live births, on the latest figures, infant mortality is 10 times that in the UK. However, only three years ago, the toll was 57 deaths per 1,000 live births. So progress is being made. It’s not as if funds are tight. According to PricewaterhouseCoopers, Indian health care has grown recently at a compound annual rate of 16 per cent. The accountants put the total value of the sector in 2009 at $34 billion. This translates as $34 per head, or roughly 6 per cent of GDP. The estimate for the current value of India’s health care sector is thought to be $40 billion.
For comparison, the annual budget enjoyed by the NHS is £110 billion (taking some 9 per cent of GDP) and serving a very small population relative to India.
Outstripping China
There is no questioning the need for a hugely expanded health care sector. By 2050, India’s population is projected to hit 1.6 billion, overtaking China as the world’s most populous nation.
The growth projection is not just based on fertility in India’s population. Life expectancy is fast moving to Western levels. Government drives against hepatitis and polio in the young will give another twist to the population spiral.
The number of inhabitants aged 60-plus is estimated to reach 189 million by 2025 – three times the 2004 total.
Alongside the population spurt, India’s economy can be expected to grow by at least 5 per cent a year for the next 40 years, according toGoldman Sachs, the bank.
Factors behind the forecast include urbanisation, an expanding middle class, and a rapid increase in the number of well-educated women entering the labour market.
But India has much to do. A quarter of the population is below the national poverty line. Some 300 million live on less than $1 a day.
What’s the government doing?
A drive to increase rural health care provision began in 2005. The rural health mission is aimed at improving primary care in the countryside so that fewer patients overwhelm specialist services in the cities. To that end, general practitioners have been trained in basic surgery.
Another Indian initiative is the government-run health insurance plan. The Government Insurance Company has the greatest slice of a market that in total attracts only some 11 per cent of the population. Premiums exceed $120 a year. Policyholders do not benefit from direct settlement, as in many Western schemes. Instead, customers pay from their pocket and apply for reimbursement. That can take months.

Health tourism
If the medical tourist wants to go “cheap”, few countries beat India. Reports from various sources point to huge price differences:
Heart surgery is typically priced at $50,000 in America, $14,200 in Thailand and $4,000 in India.
For liver transplants, it’s $500,00 (America), $75,000 (Thailand) and $45,000 in India.
For bone marrow transplants, prices are closer – $62,500 in both America and Thailand. In India, the bill is roughly halved.
Clearly, with some of the treatment costs a fraction of the American rates, flights and a week or two staying in a top hotel are minor factors.
India has quickly developed a lively trade, despite the known hazards of medical tourism – variable infectious-disease rates, different medical-accreditation standards for staff, and exposure to organisms against which the patient has no built-in resistance.
This last point is a particular hazard for people in fragile health. Dysentery and mosquito-borne diseases such as malaria, dengue and chikungunya fever are widespread and could derail recovery. Long flights in cramped airliners are a known risk for circulatory problems.
Most of the possible risks do not apply to established expats, who have a range of Western-level hospitals to pick from. Staff speak English, have the most modern equipment and direct links with Western hospital chains.
One such, Wockhardt Hospitals Group, is partnered by Harvard Medical International. Hospitals in this group, based in Mumbai and Bangalore, are among the best. The 400-bed Bangalore unit specialises in cardiology, orthopaedics, neurosciences and women/child care.
Wockhardt Mumbai claims very high diagnostic facilities among the usual range of services, including orthopaedics. It advertises total hip replacement at $6,500 (compared with about £12,000 in a private hospital in UK). A total knee replacement also costs $6,500.
Dr Sneh Khemka, medical director of Bupa International, knows the country well. “There are medical centres in the cities that really are truly excellent, especially Mumbai, Chennai and New Delhi.” Other cities with top-class hospitals include Hyderabad and Bangalore. But there are not enough new facilities outside the urban centres.
One exception is the Rajiv Gandhi Super Specialty Hospital, a public-private partnership, opened in 2000. It involved the Apollo Hospitals Group and the government of Karnataka, with support from the Opec fund for international development.
Dr Khemka said: “The tier-one cities are world class, with international patient clientele, and the tier-two – the Hyderabads and so on – are certainly able to cope with their metropolitan communities. But clinics and hospitals are still underinvested by government and are a massive problem.
“Sometimes the uninformed perception is that India is a dirty place and there is a higher rate of infection. But if you look at outcome data – and we’ve done quite a few inspections of hospitals in India – you’ll see they have much better outcome records than many places in Western Europe. They have meticulous attention on quality and safety.”
Bupa International has close ties with the Max hospital chain in India. Newly qualified consultant surgeons in such hospitals were about a third more experienced than their European counterparts because they were not hampered by the EU’s working time directive, Dr Khemka said. And “hotel” services in leading hospitals were outstanding.

Medical insurance
The Foreign & Commonwealth Office urges Britons going to India to buy holiday or international medical cover. It states: “You should take out comprehensive travel and medical insurance before travelling. Check exclusions, and that your policy covers you for all the activities.”
The FCO adds: “Local medical facilities are not comparable to those in the UK, especially in more remote areas. In major cities private medical care is available, but expensive. For psychiatric illness, specialised treatment may not be available outside major cities. ”

International premiums
The insurer Aviva comes out well in a list of insurers recommended by brokers Medical Insurance Services of Brighton. Aviva International Solutions, a comprehensive plan but with reduced outpatient cover, costs £715 a year for a 25 year-old in India (£643 budget).
AxaPPP comprehensive with a £100 excess costs £866 for the same person (£670 budget), while Medicare International is £1,203 (£912 budget).
For a couple (aged 34 and 31), the Aviva scheme is again cheapest at £1,615 (£1,450 budget). Again, outpatient caps apply – but no two schemes are fully comparable, as with all medical insurance plans.

Hazards
Usual hygiene advice applies strongly. The FCO says: “Take care with your water and food hygiene. Drink or use only boiled or bottled water and avoid ice in drinks. If you suffer from diarrhoea seek immediate medical attention.”
Bird flu outbreaks have occurred most recently in the north-eastern states of West Bengal and Assam. “As a precaution avoid visiting live animal markets, poultry farms and other places where you may come into close contact with domestic, caged or wild birds,” says the FCO. “Ensure poultry and egg dishes are thoroughly cooked.”
Prevalence of HIV/Aids is greater in India than in the UK: 0.3 per cent of the adult population as opposed to 0.2 per cent in Britain.

Patchwork
Europeans in rural India are unlikely to find health care to Western standards. But Indian cities are very different. As Bupa’s medical director puts it: “If you are going for elective or emergency treatment, it is absolutely fine to go to the centres in the big cities.”
This article was originally published in The Telegraph Weekly World Edition

Obama: Cover Birth Control; 8 Egyptian Women Win


The Obama administration said Jan. 20 that health insurance plans must cover contraceptives for women without charge, and it rejected a broad exemption sought by the Roman Catholic Church for insurance provided to employees of Catholic hospitals, colleges and charities, reported the New York Times. But the administration said it would give some employers affiliated with churches an extra year to comply, meaning that coverage would not begin for their employees until well after the 2012 elections.

Church leaders had personally appealed to Obama to grant the exemption, and he made the final decision on the issue after hearing all points of view, administration officials said

Wow! No internet required for Rajinikath’s website


 

New Delhi: A new website has been launched, dedicated to superstar Rajinikanth, which runs without an internet. It is shocking but true that you need not an internet connection to browse the superstar’s website.

It is said that if you switch on your internet connection, the site will stop working. Visitors to http://www.allaboutrajinikanth.com were warned that he is not an ordinary man and this is not an ordinary website. It runs on Rajini Power and netizens are asked to switch off internet connection to browse the superstar’s website.

Users can read Rajini’s history of both real and reel life from the beginning, browsing through famous Rajini jokes about impossible feats only he can achieve.

Webchutney‘s creative director Gurbaksh Singh, who developed the site, said that this unique website is a tribute to Rajinikanth.

The websites reflects Rajini’s signature style with a heady mix of foot-tapping music, vibrant splash of colours, quirky quotes and illustrations, and also icons in true Rajini style and lingo.

If a visitor attempts to re-connect the internet, an error message will appear in a Rajinikanth’s style.

“Aiyyo! That was unexpected. To keep browsing, switch off your Internet,” reads the message.

As per the reports, the website got 10,000 visits just after few hours of its launch. It has also become popular on Facebook and Twitter.

According to Singh, after a few iterations and testing, they cracked the code required to build the world’s first unique website that runs without switching on the internet and which is as awesome and unbelievable as miracles and stunts associated or performed by the superstar himself.

Munija says No to Child Marriage


Sixteen year old Munija Khatun reads in Class X and lives with her parents Samsul Momin & Rumela Bibi in Mahisasthali village of Samshergunj Block of Murshidbad district. As Munija is a beautiful looking girl, on the way to school she often faced comments with sexual overtones. So Samshul thought it was better to get her married as early as possible to ensure safety. Thus it was decided that Munija would discontinue her studies and her marriage was arranged.

Munija was very upset and informed ASHA’s field representative about her father’s plan of getting her married. ASHA’s field representative took Munija to meet the women’s reflect circle members and shared with the women Munija’s problem. The women in the reflect circle had come together with support from ASHA and had become conscious of their rights through participation in awareness sessions and were determined to address social customs which discriminate girls and women. On the very next day the women visited Munija’s place and talked with her father. Her father explained why he was arranging the marriage, which was according to him for protection of Munija. The women opined that marriage was not a solution for the problem. Moreover marriage at an early age and depriving Munija from opportunities of school education was detrimental to her development. But Munija’s father was not at all ready to listen to the Reflect Circle Members. Munija also expressed her reluctance to get married strongly after feeling supported by the women.

Mean while the women of the reflect circle had a meeting with the boys involved in harassing Munija and pressurized the boys to stop such unacceptable behavior and warned them that if they did not pay heed to their advice they would report to police . The boys committed to the women to change their behavior and attitude. They also went with the women and assured Munija’s parents that Munija will never face this problem again. Samshul finally agreed to postpone the marriage. Now Munija is attending her school regularly and she is not facing any problem on the way to school.

Adolescent reflect circles support Tuktuki to prevent an early marriage

Fifteen year old Tuktuki Khatun lives in Kashimnagar village of Block Suti II in Murshidabad district with her father Moimul Sk, a daily labourer and mother Baby Bibi, homebased beedi worker. Her 17year old brother has migrated in search of work and two elder sisters are married. Tuktuki is Illiterate and she has never attended school. She helps her mother in beedi rolling. Her marriage was fixed with her maternal cousin on 12th December 2011.

Tohamina Adolescent Reflect Circle was formed with support from ASHA in 2009 as a forum for adolescent girls where they could discuss and learn about various health, nutrition & social issues affecting their lives and their rights and gain confidence to express their concerns/views. They had all learnt about the legal age for marriage, hazards of early marriage and legal provisions to prevent Child marriage. During the observation of International Fortnight to prevent Violence against Women & Girls, the reflect circle girls under leadership of Asnara Khatun had taken the pledge to make their village child marriage free. The circle had atken up the issues of promoting rights of girls to education and preventing child marriage as their priority issues. They were also supported by the Women Reflect Circle members in the village.

When the girls came to know of Tuktuki’s marriage they went to her house and circle Visit Tuktuki’s house and tried to explain her parents that their daughter is only 15year she is not physically and mentally fit for marriage. They also mentioned that organizing child marriage is punishable under the law. But her parents were very adamant and did not want to discuss anything with the girls. The members of Tohmina adolescent circle along with the women Reflect circle members again visited Tuktuki’s house. Baby Bibi on that day expressed that she was not in favour of the marriage at this point but her husband’s decision was final. Tuktuki also did not want to marry. Moimul Sk was not ready to discuss and listen to anyone.

After several attempts the adolescent girls realized that to stop this marriage, they need help from the police and District Social Welfare Office. The girls had already met the District Social Welfare Officer (DSWO) and Protection Officer at Baharampur during their Annual Sharing Meet and DSWO had given his number for contact in emergency. Asnara, the circle leader spoke to DSWO over phone about the situation and requested his help. On the very next day the Police came to the village and talked with Tuktuki’s parents. Subsequently the marriage was postponed.

 

(Association for Social and Health Advancement(ASHA) has been engaged over last eight years in addressing adolescent health, nutrtion& development issues and working for promoting adolescent rights and undertaking community/school based interventions for empowering adolescent girls and boys.I am sharing  the stories of Munija, Tuktuki & Tohmina adolescent reflect circle who have been appreciated by the Honourable President of India on 17th January for saying no to CHILD Marriage.)

The entire village watched silently


The place inside the house of Govindaraju where Suvarna (inset) was forced to hang herself to death by her own father.

The place inside the house of Govindaraju where Suvarna (inset) was forced to hang herself to death by her own father.

January 14, 2012 By Praveen Kumar

No one came to Suvarna’s rescue. We were the only three women who saw the entire honour killing. “There were around 10 men, including her father beating her and finally hanging her to death. The entire village watched silently,” recalled 70-year-old Tholasamma, Govindaraju’s mother and his sister-in-law Thayamma.

Tholasamma and her two daughters-in-law, Thayamma and Mangala Gowri, are the main eye witnesses to the honour killing.

“Suvarna kept requesting her father and others to spare her and allow her to go away from the village with Govindaraju. But they only told her she deserved to be killed as she had brought dishonour to their caste by falling in love with a lower caste youth,” said Tholasamma and Thayamma. The three women ran out of the house with the children fearing that they too would be killed. ”

Till date, we do not know where our father-in-law is. Mangala Gowri is taking shelter elsewhere and we have no news about her.My two small children, including a two-year-old, are staying at different places. It has been several days since I have seen them,” added Thayamma, recalling that she had advised Govindaraju to forget Suvarna because of their caste differences.

“He had even left the village two months before the incident. But the girl was not ready to live withou him although she was engaged to someone else. More than the relationship between the two, what mattered to Suvarna’s father was their caste,” she said disdainfully. Her own life has clearly turned upside down since the incident.

I have never seen anyone being killed this way

“I will never ever return to my village where Suvarna was killed in the most barbaric way by her father and others,” said 27-year-old Govindaraju, also called Gundda , pouring his heart out to Deccan Chronicle on Thursday.

The location of the meeting will be kept a secret on his request as he believes his life too is under threat from Suvarna’s father and family.

Govindaraju belongs to the Madiga caste, considered the most oppressed and exploited. Suvarna, who did not care that he belonged to a lower caste while she herself was a Vokkaliga, was in love with him for five years. Although this did not go down well with her family, the couple never dreamed their love affair would meet such a gruesome end.

“Even in the most violent of films I have never come across any person being killed the way Suvarna was. She was dragged by her legs on the concrete road and beaten with wooden logs. She was brought to my house and asked to commit suicide by hanging. When she did not, she was killed by hanging. How can any father kill his daughter this way? I want these people to be punished for Suvarna’s soul to rest in peace. Like all other lovers, we were in love. I agree that we belonged to different castes. But what has her father gained by killing his daughter,” he lamented.

“Had the police acted fast on November 6, when Suvarna was being murdered, she would be alive today. My brother, K Thimappa, had rushed to the Koppa police station and informed the police about the tension in our village while Suvarna and I were being beaten. If the police had reacted fast, she would not have been killed,” he maintained.

Although he managed to escape through the sugarcane fields behind his house, he found it difficult to run as he was badly beaten.

“I had to drag on till I found a lorry transporting sugarcane. I reached the main road with the help of the driver and from there I came to my relative’s house on the outskirts of Bengaluru. If I had not escaped, I too would have been killed the same day,” he shuddered, unwilling to emerge from hiding as he is certain that will be as good as signing his own death warrant.

UIDAI invades privacy, endangers security


In a letter to the prime minister, Union home minister P Chidambaram is reported to have demanded that the Planning Commission be instructed to bring a note to the Cabinet on the status of the Unique Identification Authority of India (UIDAI) so that there is clarity over which agency — the Registrar-General of India (RGI) or the UIDAI — will carry on with the task of capturing the biometric data of the population. The letter expresses unhappiness over media reports over turf wars between the UIDAI, which comes under the nodal authority of the Planning Commission, and the RGI under the home ministry. The crux of the issue is the security of the biometric data being collected by the two agencies. While the RGI collects data through officials visiting homes, the UIDAI collects it through private agencies, who ask people to come over to their collection centres.

This is a much more important issue than the dispute over jurisdiction and, though belatedly, Chidambaram has raised the right issue. Only last month, the parliamentary standing committee on finance had rejected the National Identification Authority of India (NIDAI) Bill, 2010 — which was supposed to provide the legal basis to the UIDAI — raising questions about the ethics, feasibility and purpose of the project as well as its legality. The committee said the UID scheme was “built up on untested, unreliable technology and several assumptions” and large-scale involvement of private agencies in collection of biometric data about the citizens of India was not only unconstitutional but a threat to national security.

In the backdrop of the parliamentary committee’s severe indictment, further continuance of the scheme is untenable. That such an ambitious project with wider implications for the citizen’s right to privacy and national security was launched without Parliament’s approval shows the UPA government’s utter disregard for law and democratic traditions. The government should scrap this scheme, which was initiated without legislative sanction, feasibility study and cost-benefit analysis.

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