As the COVID curve flattens and is probably set to begin dipping as it inevitable would, other than the precautions and preparedness for any possible new waves in the future, there are certain other very important things to reflect on for the benefit of the society in the years and decades to follow. The most important of these can begin with a largely ignored question: why has the COVID death rate in Manipur been one of the highest in the entire Northeast and the country? In terms of number of persons infected as well as deaths, Assam is the highest, but this is expected for the state’s population is much bigger, more than 11 times that of Manipur, but in terms of deaths per infection, Manipur is ahead. Manipur’s population is less than Meghalaya and Tripura too, but in terms of number of infected persons, Manipur is ahead of them and second only to Assam. In terms of death per infected, it is only marginally below Nagaland and Meghalaya, indicating that these two states too will need to do similar introspection as Manipur. The most important of these questions is, what possibly can be the explanation for this high death rate. In attempting to answer this question honestly, nobody must be treated as the holy cow, immune and exempted from any adverse scrutiny.
The daily tabulated official figures of COVID cases cannot lie and Manipur seems to be in the frontline of number of people getting exposed to the virus and falling ill. While this can be attributed to factors like level of congestion of living environments, lack of public discipline etc., and not necessarily only government containment strategy failures, the higher rate of deaths can only mean one thing – inadequate or poor health service. From the volume of authoritative literature which have poured out in the course of the one and half year of the pandemic, as well as actual experiences of communities during the same period, we now know COVID is deadly and can cause death, but it is far from a death sentence. Given timely and proper medical attention, it is generally only a small percentage of patients who do not recover, and most of them have been people already weak with age or other illnesses (comorbidities). So far, the explanation forwarded for this unusually high fatality rate is that that many people generally seek hospitalisation only when they are on the last leg, therefore either difficult or impossible to rescue. But the question that should follow naturally is, why or what have made people reluctant to approach hospitals? What are the compelling reasons, if any, for many to delay hospitalisation? Nobody can be averse to have their health taken care of by health professionals unless there are factors inhibiting them. There is of course a small obscurantist minority who disbelieve in science and live in COVID denial still. So long as they do not disrupt public life or COVID battle strategies, they can continue living in their closed cells and should not be anybody’s worry.
Although serious flaws in health care infrastructure are showing up much more acutely in the past two years or so of the COVID crisis, even in the years that preceded the pandemic, these banes had already become visible periodically whenever there were eruptions of health related law and order problems, mostly in the shape of unruly patients’ parties going on a rampage at what they perceived as casualties resulting from negligence at these hospitals. Related to this in a subtle way is also the phenomenon of the mushrooming of private hospitals, clinics and others providing specialised health related services, serving as an alternative to tax-subsidised government hospitals. Expectedly, private health facilities are beyond the reach of a larger section of the public and this section is left to depend on government hospitals only for their health emergencies. This is understandable to an extent, as private hospitals are also businesses which run on the fees paid by patients, but as in any business, there must be regulatory laws to distinguish between fair profit margin and unscrupulous profiteering in order these institutions can remain within the revered domain of public health service and not merely a business. This is especially important in times of a public health crisis such as we are going through at the moment.
On the other hand, government hospitals do not have to worry about earning money for they run on public tax money. What they instead lack generally is accountability and level of commitment of their health professionals. As in most government services, here too absenteeism and duty neglect are very often a problem. This is accentuated further by the fact many of these professionals also either run their own clinics or else work in other private hospitals to make more money. Can these extra activities simply be classed as private humanitarian practices to meet community demands and not organised business? Not always, although there are many exceptions. Most of these private institutions are also run not as non-profit charitable organisations funded by public donations or by basic cost covering fees, but as registered for-profit enterprises. Often this has also resulted in those running these enterprises to focus attention and energy more on their own enterprises, and at the cost of commitment to the government hospitals that employ them. The unfortunate deterioration of patients-doctors relationship, which has become a major bane in Manipur today also has this as one of the many factors. It is true patients’ parties are often unruly and selfish, incapable of understanding that not all health casualties can be prevented, but as they say, it needs two hands to clap. Regulating the practice of one professional keeping two jobs will not only be towards ameliorating this situation, but also leave more job vacancies for newer batches of qualified health professionals even as jobs become scarce in this sector too.
The result of a combination of all these little hiccups in this sector probably is behind the general disenchantment with the public health services in the state which has become quite pronounced during the current crisis. People, except the well-endowed, are reluctant to rush to private hospitals for fear of ending up with huge debts beyond their means to repay easily. They are also reluctant to go to government hospitals for fear they will not be looked after well, unless they desperately begin to need professional intervention. This in all likelihood is the reason for Manipur’s very high rate of fatalities in the current COVID tsunami. Once the storm passes, the government will have to take note of this and perhaps institute a high-power committee to look into the matter to evolve strategies to put things on track again for the sake of the future welfare of all.
Editor, Imphal Review of Arts and Politics and author