Encephalitis Epidemic in Purvanchal Compounded by Medical Discrimination

Presenting the budget for 2014-15 Finance Minister Arun Jaitley announced that institutions such as four new AIIMS would be established. There was mention of one of these to be established in Purvanchal in U.P. but no specifc place was mentioned. After this announcement the demand for an AIIMS in Gorakhpur of eastern U.P. was redoubled. This demand had arisen three years ago and has become an important issue today for the people of this region. It was a main issue even in the recent Lok Sabha elections. As BJP candidates have won from all seats here except Azamgarh, it would be a problem for them to face and answer the people of Gorakhpur if the new AIIMS is not established in Gorakhpur, because there is much talk that this AIIMS will be established in Varanasi, PM Modi’s constituency, where a well-reputed medical institute, BHU, already exists.

The talk of AIIMS being established in Varanasi prompted the BJP MPs of Gorakhpur and nearby constituencies to make a statement in the Press that they would meet PM Modi and demand that the AIIMS be established in Gorakhpur. It is now a fortnight since that statement was made but the MPs have not yet met Modi or raised the issue with him. If the AIIMS is established not in Gorakhpur but in or near Varanasi, it will be another great injustice to the people of Purvanchal.

For Gorakhpur and 14 districts of eastern U.P. and 4 districts of western Bihar, AIIMS is not merely a demand for a high level medical institute; it is an expression of the anger of the people against the huge neglect of remote areas in the field of medicine. This neglect is happening not just in this area but in remote areas across the country. Even a cursory glance will tell us that all high level medical institutes are located either in State capitals or in the areas of big and powerful leaders. In exceptional cases where there are medical institutes in some other areas, these remain in name only, for till today they lack doctors, essential equipment, and resources.

In the year 2006 the Pradhan Mantri Swasthya Suraksha Yojana (PM Health Guarantee Scheme) was started with the aim of ensuring high level health facilities in remote areas.

This scheme had two main objectives: to establish institutes like AIIMS in every State, and to upgrade and make superspeciality facilities available in medical colleges. Establishing institutes like AIIMS and upgrading medical colleges was also to have helped in increasing the number of doctors. The selection criteria for location of AIIMS were to have been human development index, literacy rate, socio-economic conditions, number of people below poverty line, and per capita income. But these criteria were grossly violated and AIIMS were established only in State capitals where good medical facilities already exist.

In the first phase of this scheme AIIMS were established and academic sessions have aready begun in six States: Rishikesh (Uttarakhand), Raipur (Chhattisgarh), Bhopal (Madhya Pradesh), Bhubaneshwar (Odisha), Patna (Bihar), and Jodhpur (Rajasthan). Under the second phase of the scheme, AIIMS is to be established in Raiganj (West Bengal), and Rae Bareli (U.P.).

Rae Bareli in U.P. was chosen for setting up AIIMS because this is the Parliamentary constituency of UPA chairperson Sonia Gandhi, whereas there is no justification for this, as Rae Bareli is barely 60 km from the State capital Lucknow where high level institutes such as Sanjay Gandhi Medical Institute, Dr Ram Manohar Lohiya Institute of Medical Sciences, and King George Medical College as well as private medical institutes are already in existence. There was widespread opposition in Purvanchal to the establishment of AIIMS in Rae Bareli, and a protest movement began. Half a dozen PILs were filed in the High Court. Seeing the growing protests, the Akhilesh government tried to pass the buck to the Central government by writing a letter to the Centre asking them to establish three new AIIMS in Uttar Pradesh. When the protests still did not abate, the Chief Minister tried to diffuse the situation by announcing that the State government would build a 500-bed children’s hospital in Gorakhpur. In spite of this the demand for AIIMS is getting stronger and stronger rather than waning.

Four blocks in U.P.—Gorakhpur, Azamgarh, Basti, and Devipatan—consist of 14 districts and between them they have only one reasonably big medical institute, which is BRD Medical College, Gorakhpur. The people of Azamgarh, Mau, and Ballia go to Gorakhpur as well as Varanasi for medical treatment. Similarly 5 districts of western Bihar (West Champaran, East Champaran, Saran, Siwan, and Gopalganj), being geographically close to Gorakhpur, come here for treatment. These 19 districts have a population of 6.25 crores, out of which 1 crore are children between the ages of 0-6. It is well known that for over three decades this region has been affected by Japanese encephalitis and acute encephalitis syndrome and according to government statistics over 15 thousand children’s lives have been lost to this disease, and around the same number have been mentally and physically disabled. This is the sickly region of Terai. Apart from encephalitis, cancer, heart diseases, gastric diseases, and water borne diseases are widespread here. Despite this there has been no attempt to strengthen the medical system here. The BRD Medical College, the lone institute established in the name of high level medical facilities, is in very poor condition. There is a huge dearth of medical teachers, and in the absence of new recruitments, they are making shift with retired doctors on contractual basis.

Compared to western and central U.P. this region also lacks proper primary health centres and community health centres. As per standard these 19 districts have a dearth of 700 primary health centres and 582 community health centres. Similarly there is a dearth of 1700 MBBS doctors in primary health centres alone.

If we analyse this year’s budget for the U.P. medical education department it is evident that the government is moving in the direction of limiting medical facilities to the urban areas. The medical education budget for U.P. is Rs. 2190 crores. Out of this the budget for the medical institutes of Lucknow—King George Medical College, Dr Ram Manohar Lohiya Institute of Medical Sciences, and Sanjay Gandhi PG Institute of Medical Sciences—is Rs. 904 crores. Now this year’s budget has allocated 68 crores for a cancer institute in Lucknow. Apart fom this 400 crores have been allocated for medical institutes in 4 VVIP areas of U.P.—Etawa, Badayun, Kannauj, and Azamgarh. More than 60% of the budget is for these areas and the remaining is for the rest of U.P. Similar discrimination was seen when out of the 125 ultrasound machines allocated for rural areas, only 11 were given to Gorakhpur, Basti and Azamgarh blocks whereas 39 machines were given to the 5 VVIP districts—Lucknow, Rampur, Etawa, Kannauj, and Ambedkarnagar.

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