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  • No more crying in the middle of the night 
  • No more playing in the middle of the street
  • No more mischief in the class
  • No more tantrums in the house 
  • No more exams to pass 
  • No more dreams to chase 

How can they, when the children are no more?

Not one, not two, 13 children died yesterday, 309 died in August alone, 1269 this year and all in the BRD government medical college, Gorakhpur, Uttarpradesh. 

This is not just because of a doctors negligence or an equipment failure or a random incident of negligence but a deliberate failure of an entire system. A system that was meant to diagnose, treat and cure, was left to decay so much that the rot just became toxic claiming innocent lives.

The CAG report published in August 2017 for the period beginning from 2011 ending 2016 March, exposes the rotten system of the BRD medical college. From failing to treat cancer patients to failing to conduct prenetal diagnosis to misusing funds to shortage of medical equipments - the medical college broke rule of law and violated the moral code of conduct. 

Excerpts from the CAG report 

✓ the GMCs failed to provide adequate treatment to cancer/heart patients as equipment such as Cobalt Teletherapy, Brachytherapy unit, Left Ventricular Assist Device, etc. were not being operated in hospitals due to lack of doctors/technical personnel/infrastructure.

✓ The GMCs did not execute Annual Maintenance Contract for equipment. As a result, the machines were not functional and tests for cervix cancer, foetal monitoring, prenatal diagnosis, bio-chemical and hormonal tests etc. could not be conducted.

✓ GMCs did not procure clinical and teaching equipment though adequate funds were provided by the Government, resulting in shortages of equipment

✓ The GMCs failed to provide adequate treatment to cancer/heart patients as equipment such as Cobalt Teletherapy, Brachytherapy unit, Left Ventricular Assist Device, etc. were not being operated in hospitals due to lack of doctors/technical personnel/infrastructure.

✓ The GMCs did not execute Annual Maintenance Contract for equipment. As a result, the machines were not functional and tests for cervix cancer, foetal monitoring, prenatal diagnosis, bio-chemical and hormonal tests etc. could not be conducted.

✓ GMCs violated the provisions of General Financial Rules while procuring equipment by extending undue favour to suppliers and purchasing equipment at a higher rate

✓ Financial management of the GMCs was not adequate as there were instances of retention funds for long periods in PLA, diversion of funds, etc

So what's next?
I'm sure the CAG report will have no affected on the administration because if a child's death didn't, then what's a report? And neither did it have any affect on the media, because the deaths continue to happen but not the coverage and further questioning. This leaves, us i.e you and me. So let's begin with questioning the authorities 

  • File an RTI with the BRD medical college to understand what steps they have taken for cours e correction. And if they haven't, then when would they?
  • Call the MLA's and the MP's and put pressure on them to not just fix the current problems but to elevate the standards of healthcare 

If we don't think we can do this, then just remember the faces of the kids who died or should we say, we let them die 

1

National Pharmaceutical Pricing Authority's move to cap pricing of coronary stents would adversely affect well-to-do patients and medical tourism industry in India

After the Delhi High court passed the order to slash the price of stents, National Pharmaceutical Pricing Authority (NPPA), a government regulatory agency issued a order on 13th Feb, 2017. This order came as a boon for the BJP Government which was busy with their UP & BMC campaign. PM Narendra Modi made it sure, that price capping of stents becomes an USP during his election speeches. Neither the Government nor the NPPA took suggestions from doctors, hospitals before issuing new regulations.

To summarise, stents were capped in 2 broad categories.
1. Bare Metal Stents - Rs.7260
2. Drug Eluting Stents and Bioresorbable Vascular Scaffold/Biodegradable Stents - Rs.29600

As of now, Abbott and Medtronic have filed for withdrawal of their premium coronary stents from the Indian market, as it wasn't commercially viable after the price cap. Boston Scientific might withdraw their premium stents too after the completion of their corporate sustainability review. Now Indian patients won't have access to high end stents even if they are ready to spend money. Government has every right to make doctors work for the poor, but they can’t deprive middle and upper class of what they can buy. This is not beneficial for a democracy. This is extreme health care rationing. Bare metal stents could be made of stainless steel, cobalt or platinum. The pricing of these differs.

It's the basic law of economics. If tomorrow, Government decides to put a price cap of Rs.30,000 on smartphones. Then Apple will only sell older iPhone models like SE, 6 and won't sell newer 7, 7S models.

To make matters worse, NPPA has rejected the withdrawal plea of Abbott and Medtronic. They also directed stent manufacturers to have stock for 6 months or face action. Basically forcing them to sell their high end products at a loss. This lame restriction could be easily evaded by importing only basic stents while not importing premium stents. Imagine, Mercedes Benz being forced to sell their high end car for Rs. 10 lakhs. This is borderline insanity, Government can't dictate companies to sell their non-essential, premium products at a specific price. This isn't North Korea.

If Government is serious of public healthcare in India then why does it spend a meagre 1.4% of the GDP on healthcare? Because that doesn't favour their PR based governance. BJP's print advertisement on the eve of BMC election read, “expensive angioplasty stent now cheaper by 85%; decision of a sensible government”. Modi Government isn't interested in reforms and instead prefers managing headlines over economy.

What should the Government have done to help the poor as well as to not harm the middle/upper class?

1. Create 4 classes of stents instead of current 2 classes.

2. Leave the last one uncapped, so those who could afford have access to newer tech.

3. Adopt an ala carte approach, making available stents at Rs. 7000, Rs. 28000, Rs. 85000 and uncapped.

4. Provide first two only through RGJAY and other schemes.

5. Use the expertise of public sector rate contracts and declare the rates at which all varieties of stents can be bought into India. Get these prices in public domain for everyone’s knowledge and information.

6. Audit the procedures in public and private hospitals through a third party.

7. Audit individual cardiologist’s annual performance to know for which class he is working more.

8. Consider SEZs for implant companies to manufacture these high end products in India.

These suggestions were provided by Dr. Sanjay Oak in his article in Mumbai Mirror.

This is how a handbook of bad policy would read. First, impose price controls. Then watch goods disappear from the market. And finally threaten producers with punishment for the shortages that your price controls have created. Multi-speciality hospitals across the country are reporting a fall in foreign patients due to shortage of premium stents. Patients are instead getting operated in Singapore, Bangkok. Thanks to this move, we are now losing valuable foreign currency too. Why is Indian Gov't promoting reverse medical tourism? Undoubtedly we need to care more for our poor, but we can’t at the same time ignore the desires of millions of people who belong to upper and middle class and who are honest tax payers. Why should they be denied a choice?

Today it’s cardiac stents, tomorrow it will be orthopaedic implants, and after that, maybe oncology drugs. There is no doubt that the government’s intentions are laudable and the efforts are an attempt to ensure equitable distribution of medical care and to curb medical malpractices. But the execution is misdirected and mal-aligned. Hospitals may hike cath lab rent per procedure and try to bridge the gap. Surgeons may prefer bypass surgical procedures. All these regulations appear as knee-jerk reactions done to control medical malpractice. I am not claiming here that everything was hunky-dory in the stent and implant business. But, putting a cap on prices is not the answer to the problem.

While Modi led BJP came to power with the slogan of, "Minimum Government, Maximum Governance". Their actions are nowhere near it. Instead the License Raj that we left off in the 1980s, is making a comeback.

8

A hate crime appears to have been committed at the Toyota Service Center in Mumbai. Yakub was brought dead to the hospital on the 29th September 2015 in an abnormally bloated condition and protruding eyes on the day he had returned to work after Eid. Otherwise in good health, the condition of his body alarmed his family enough to decide on an autopsy. Until this point, all they had to go on was his colleagues telling them that he had suddenly fallen ill and bloated as they carried him to the hospital.

His death certificate from his autopsy at the KEM postmortem center, conducted by Dr. Sunil Vidhate and Dr. H. M. Pathak states as provisional cause of death:

"Respiratory failure due to pulmonary air embolism with pressurized air in large and small intestine, thoracic and abdominal cavities, and scrotal sac" (UNNATURAL)

death certificate of Mohammed Yakub Shaikh
death certificate of Mohammed Yakub Shaikh speaks clearly of embolism from bodily cavities being filled with pressurized air

In other words, pressurized air was inserted into his body through his anus with enough force to fill him up like a balloon and cause his death within seconds due to air entering his blood vessels. Something his colleagues had missed describing to his family. The narrative then changed to them having some "fun" with him. Apparently filling a person up with air from the industrial compressors used in a service center is the idea of fun in a Toyota Service center?

What follows is more appalling. The police have bought this "fun" theory without hesitation and everyone else also apparently seems fine with it. Here's a rough translation.

Santosh Arekar while teasing and harassing Mohammed Yakub Shaikh got angry and using a pressure pipe in the Toyota Service center, filled Mohammed Yakub Abdul Hassan Shaikh with air.

Bewildered and intimidated by the murder, Yakub's family was helpless in the face of people who all seemed to think that it was "fun" and were fine with it. They are having difficulty being heard and having their concerns addressed. Santosh Arekar has been arrested under Section 302 of the IPC alone, in what was clearly a targeted hate crime (mentions of anger against Muslims over Qurbani - slaughter at Eid).

As of now, AIMIM appears to be supporting them by insisting on action being taken.

The question is larger. Why are they in this situation? Why is another Muslim man murdered in a hate crime with the state conniving to make light of it?

What are we planning to do about ongoing hate crimes against Muslims for no fault of their own?

There is a need for the state to ensure speedy and factual justice. There is also a need for Toyota to clarify what appropriate use of the pressurized air in their Service Centers is, given how no one seems to see filling people with it as extraordinary even with a man dead.

The remaining documents of the case may be found here: mohammed-yakub-shaikh-murder

 

Yakub is murdered at Toyota Workshop in Mumbai, Police is not ...Yakub is murdered at Toyota Service Centre in Sewri, Mumbai allegedly by colleagues on 29th September 2015, when Yakub joined office after Eid. Family accuses Police of hushing up the matter as a "freak accident while having fun". Fun? Pressured Air is sent into a person and that is funny? Toyota Service Centre is not providing CCTV footage of the workshop. According to the family, Yakub was punished by this colleagues for doing Qurbani in Eid. Listen to what Yakub's family has to say. [Video courtesy: Akeel Shaikh, Mumbai]For FIR and Postmortem reports click here:https://www.facebook.com/milligazette/posts/1109366419081007

Posted by The Milli Gazette on Monday, October 12, 2015

Update: AIMIM MLA Waris Pathan has stepped up to support Yakub's family.

How big is the dengue epidemic? There is not much coverage that gives us an idea of the scale, so I have attempted to create a map from various pieces of small news published in different newspapers in last couple of months.

This page will be updated with new reports when I come across them.

[mapsmarker layer="12"]

Caution: Do not take asprin or ibuprofen as self medication if you have fever that matches the symptoms of dengue. Asprin increases tendency to bleed. Dengue reduces platelet count and increases tendency to bleed. Asprin given to a dengue patient will increase chances of hemorrage and shock.

Covered in small news stories is a large picture of the dengue fever season this year. Dengue fever is caused by the dengue virus that spreads through the blood feeding of the aedes female mosquito, particularly A. aegypti. The number of cases of dengue fever worldwide have gone up by 30 times in the last fifty years, and are increasing in India as well. The cause is theorized to be increasing urbanization and ecological changes that allow the aedes aegypti mosquito and the dengue virus to thrive. While most patients of dengue fever will make unremarkable recoveries and will not even require hospitalization, some cases can escalate to bleeding, shock and death.

There is no vaccine or cure for dengue fever and treatment is symptomatic. The best bet for protecting yourself is to prevent aedes aegypti mosquitoes from breeding and biting. You should eliminate mosquito breeding grounds, kill or repel them from homes and living spaces and to use mosquito repellent and cover your body if spending any time in an area where mosquitoes are active. Watch out for mosquito bites during the day and particularly at dawn and dusk, when the aedes aegypti mosquitoes are most active.

Do not think that upscale localities are safe. Surveys by Mumbai's BMC found that over 60% of mosquito breeding spots detected were in upscale localities. This year's victims of dengue fever include Gurgaon’s police commissioner Alok Mittal and Haryana chief minister Bhupender Singh Hooda's son-in-law, Assistant municipal commissioner (Mumbai) Chandrashekhar Chore and Deputy Director of National Institute of Virology, Dr. M S Chadha. The wife of a senior IPS officer died of dengue fever. The point is that breeding mosquitoes do not look at the class of the locality or education of its blood sources. Better be safe than sorry.

Symptoms for dengue fever, particularly in the earlier stages can be vague. However, please approach a doctor and ask to be tested in case of high fever, chill, pain behind the eyes, severe stomach pain or stomach upset. Tests like NS1 or MAC Eliza test (for viral antigen) can confirm the presence of the dengue virus. Worsening abdominal pain, ongoing vomiting, liver enlargement, mucosal bleeding, high hematocrit with low platelets, lethargy or restlessness and serosal effusions are all considered to be serious warning signs and will usually prompt doctors to recommend hospitalization. Any bleeding from the nose or blood in urine should be reported to a doctor on an emergency basis.

More information will follow on this blog, but for now, here are the highlights.

Information on dengue, mosquitoes that spread dengue and prevention
Information on dengue fever, mosquitoes that spread dengue and prevention
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