Imphal Review of Arts and Politics

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Manipur's official COVID response has left much to be desired. Private health facilities are allowed to have their ways unchecked to remain prohibitively expensive, and government facilities suffer from abject lack of commitment

My COVID Ordeal Taught Me it is Culture and Attitude, Not the System Which are the Problem in Manipur

One of the major issues of the failing education system in Manipur, highlighted, in a recently concluded state level seminar on educational scenario of the state at Manipur University is: Corruptions in recruitment and posting practices. It would not be wrong to also assume that the same issue applies across all social services institutions in the state. Most of the staffs in the top, middle and bottom level of government service institutions are there where they should not have been. We often come across staffs in the government offices who neither have the appropriate attitude, aptitude, and skills to do the jobs they are paid for. So, we have medical staffs, teachers, police personnel who conduct and behave with service seeking people according to their personal interests, whims, fancy, moods, and egos. Recruiting such misfits in all the government departments are a great disservice to the people who elect the government, but they continue to be in the wrong places because they provide great service in sustaining the political bosses who appoints them. The same political class also blatantly come back to the people promising to check corruptions in the public offices after every five years.

This flaw in the governance and administration of government offices under pressures of the political bosses has been pointed many times by some of the honest civil service officers after their retirements. They also expressed their frustrations on frequent interference and inducements by their political bosses in taking wrong decisions instead of the right ones based on the facts and figures and merits of the situations during their service tenures. But such honest officers are few. Let their numbers grow. Many of the retired civil service officers who successfully worked hand-in-hand with their political bosses, mutually satisfying their vested interests, do also tend enter into politics as post-retirement settlements to continue the vicious cycle of corruption in the state and society – breeding mediocrity and sub-standard lives instead of creating social conditions for quality of life with dignity. This is not only local state-specific problem but part and parcel of a larger political system in India.

This issue assumes extreme urgency of serious public attentions especially when we have witnessed how the politically corrupted State failed the Health System during public health emergency situations. Govt of India failed to prevent nearly five lakhs reported deaths due to Covid-19 pandemic through third waves even as the experts estimate much more unreported deaths in multiple times in the country. As on date Manipur counts 1,30,490 Covid-19 positive cases and 2027 total deaths showing 95.80% recovery rate during the same period. The systems and mechanisms of responding to the pandemic that were put in place during the first and second wave seems to remain either resistant to change to suit the nature of third wave or showing signs of fatigue. This is based on recent experience of having tested Covid-19 positive in my family.

Three in my family tested positive. We all are double dose vaccinated. Right after the test result of member of my family came in I as a responsible citizen, took all six members of my family for covid test at the Art & Culture Dept building, Palace ground for three reasons. Next day January 2, in the evening my wife and I were listed among the Covid positive as informed by Leikai Club Covid Response Team. Though it was in total disbelief, at least for me, we immediately took safety and precautionary measures to contain and isolate ourselves at home as the official SOP. All these happened without the Covid Control Room making any efforts contact us, directly. The following day on 22nd Covid Data center contacted us on phone and asked whether we are in home isolation and whether we have separate toilet facilities. I said, ‘yes, we are at home isolated from rest of the family but have only one shared toilet. Knowing that we have only one toilet they did not bother to ask whether we like to move to the Covid Care Centre but informed us that they are sending some medicines after assuring we have no other health complications and in return we were asked to submit two forms duly filled and signed, immediately. In the afternoon a staff from the local PHC delivered some tablets which included Vitamin C, Zinc, Bone-D3, Ivermectin and an Oxymeter with oral instructions which were passed on to us through another person in the neighbourhood. Soon after, I got soft copies of the two blank forms through my phone as reproduced here below. I was asked to handwrite the same, sign and submit:

Form No.1: Undertaking by patient on self-isolation….

Point-1: I ………………………….. S/W of …………………….. resident of ………………being tested as positive Covid-19 infection, do hereby voluntarily undertake to maintain strict isolation at home at all times for the prescribed period (without mentioning the period).

Point-2: During this period, I shall monitor my health and those around me and interact with assigned surveillance team / with the State Helpline (1800-3453818) in case I suffer from any deteriorating symptoms or any of my close family contacts develops any symptoms consistent with Covid-19.

Point 3: I have been explained in detail about the precautions that I need to follow while I am under self-isolation. I am liable to be penalized and persecuted under applicable laws for any non-adherence to self-isolation protocol.

Form No.2: Hospital Admission Refusal form

I …………………………….. have been advised by Dr. ……………………. that I need to go to hospital for urgent medical care and treatment.

I have been fully informed about the risks and consequences of not going to hospital and these include: (set of summary of risks explained) ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….. (no list of risks as stated is filled up, here)

Despite this advice I have chosen not to go to hospital. I understand that this decision goes against the medical advice that I have received and will seriously compromise the care that can be provided to me.

I accept sole responsibility for the consequences of this decision

Reading through the two forms I was confronted with the flaws in the entire procedures I was asked to follow. Firstly, it is clear that not adhering to the instructions in both the Forms I will be liable for legal actions even after informing the help center that we had no separate toilet facilities for home isolation. No clear instructions on do’s and don’ts were also provided to me.

Secondly, more serious problem is with the Form-2 because in all the communication I have nowhere said I decide to stay home by refusing to go to the hospital for urgent medical care and treatment, but I have been reporting for the inadequate toilet facilities at home. I felt I was asked to own up a situation in which I have acted against the law which I did not commit. Even while I was trying to cooperate with the health personnel to seek proper medical advice for best care option all options were summarily closed while giving priority to getting the forms signed to complete certain formalities.

Thirdly, medicines provided to us were nowhere mentioned in the two forms. It was passed on to us informally without any written prescriptions and physical examination of health situation of both of us. Reluctant to take the medicine since our health conditions was not worrisome, I checked the side effects of Zinc and Ivermectin tablets on the internet and found it was unsafe for us without proper medical checkup and advice. So, I texted the same Covid helpline center expressing my inability to sign both forms because the terms and conditions for which I should be undertaking the legal liabilities were not suitable to my case due to the flaw in the procedures. To my surprise instead of being helpful the attending staff at the helpline center texted me the following messages,

Covid Helpline: “So according to this condition” (meaning, since I cannot sign the forms), “We can’t give your discharge paper”, “Since you denied”, “We won’t take any responsibilities”

Then I wrote back: “We are not asking for any discharge slip. What we are asking is proper medical care and advice according to our house and health conditions as per the laid-out procedures”. “Get me line to the concerned doctor. Do not jump into your own decisions over the phone. You will be held responsible for procedural lapses.”

Covid Helpline: “mind your language”

I got disturbed and replied: “Is this the way you treat with Covid patients? Be careful”

Covid Helpline: “If we didn’t give your discharge paper from where will you take”.

Seeing no use of further communication with a young lady on the phone I talked to the DSO Imphal East shared my concerns and expressed the need for proper supports and advice. The doctor understood the situation and as said I am open to follow all necessary advice including staying at Covid Care Centre based on proper assessments of the ground realities of home isolation and health situations of two of us. Following this discussion with the doctor all communication stopped from the Covid health care centers. Without further going into what followed thereafter and how we took care of ourselves till date some reflections on the experiences may help to understand the state health system’s response to health emergency situation and plight of infected persons.

Firstly, what it is like to be infected by Covid-19 pandemic and how does it impact the ordinary citizen’s normal life, especially those who are non-salaried and struggle to make their living? The live world of day-to-day life suddenly stops. You get cut off and isolated, you lose all your ascribed and acquired social status, power, wealth, roles and responsibilities in the family and community. You are suddenly disrobed of all the respects and dignity of life. You are left alone, confined, and isolated out of sight. You survive on sympathy of a few who really care for you and daredevil philanthropic services of few pious souls while being isolated. You cannot meet anyone, nor anyone would like to risk meeting you for the fear of infection and life risks. In a matter of a moment, you cease to be a right bearing living person in the society as you are suddenly reduced to a number in the spreadsheet of Covid-19 Databse. Worse is, when people in your neighbourhood who have some grudge against you lets you know directly or indirectly that they justify your suffering as deserving because you are a bad person to them. It is said, ‘isolation’ is the greatest punishment for human-being but the greatest irony of Covid-19 pandemic is that you get the greatest punishment for no fault of yours! The only fault ordinary people may have committed may be ‘ignorance’ that again raises a question: What is the responsibility of the state education system and services if it is not to educate its people to dispel their ignorance? It is in such situation the public health system comes in to save your life upholding the human rights and dignity guaranteed under the Constitution.

Secondly, how is the state health system responding to the situation. One can imagine the importance of professional and ethical services of all personnel employed under the health services in responding to such a tragic public health emergency which can wipe out the entire population. The system is mandated and provided with all resources and safety measures to save life in order to restore the sudden loss of human rights and dignity of all infected citizens in such a health emergency situation. Elsewhere, many have, from top to bottom, exhibited exemplary sense of duty at the cost of their lives and safety measures in saving lives of many during this pandemic. While the entire nation acknowledges such highly professional and ethical services of these health personnel in best performing state, the situation in a state like Manipur health system’s responses to the pandemic quit obviously are highly wanting as seen through three consecutive waves of Covid-19 pandemic. This is evident from my personal experiences.

The response systems and mechanisms from the test centre to the care centre is bafflingly and apparently dehumanizing and blind. The response is apparently mechanical, one size fit all approach. Instead of making any sensible efforts to understand the situation of Covid patient the attempt is made to force upon certain formalities overlooking step by step processes of examining the specific situation of the patients, physical examination of home isolation and patient health condition. The entire procedures are being administered over phone including treatment without proper written prescriptions, instructions and guidelines. They almost seem to assume that all patients are equally knowledgeable as they are and would be able to understand everything that needs to followed at home stay condition. For them a patient may be punishable under the National Disaster Management Act if you are ignorant or if you try to raise question on their faulty response procedures. Instead of providing professional and ethical services for which they are being paid from public taxes they seem to be interested in finding faults with the patients. This is evident in the text messages above. There is another angle to be explored.

The way in which health system responses in such emergency health situation also seems to aim at frustrating the needy people of their services enough to bow down to a level of either begging for their sympathy or bribe them to safe own lives or indirectly motivate people to rely on private health service providers. It is evident in the state. Health services have become a booming business since 1990s. But the tragedy for unemployed patients seeking private health services is that there are increasing number of people who get robbed off all their savings, property and assets once they enter into any of these private hospitals with serious illnesses. They save your life but leave nothing to live on when the treatment is over!

Finally, this article is not to blame any personnel in the health services but an attempt to invite all to reflect together on the culture of corruption within which the political institutions functions from centre to the state in Manipur. And unless the political class of our society take a serious relook at their own culture and practices for necessary reformation and correction, they will cause lots of suffering to the people far beyond their capacities to bear. Corruption in political affairs is dehumanizing. Political class look at the voters as number and their only efforts to measure the value of each voter in terms of money. Beyond the close relatives, some voters are purchased with kind words and personal touch and others are purchased at any higher cost to catch the winning margin. This attitude towards the citizens is the problem which has percolated down to staffs and personnel in all the social services institutions. This attitude can be changed if there is a will to do so for the advancement of the society.

Economic development is in the interests and benefits of all: both the elected and the electors, but this development can happen only when education and health systems provide quality services. Unfortunately, it is these two sectors which are most abused in the state. If the political class looks at these two sectors as money making institutions for personal gains and employment opportunities for their party supporters and job buyers, then only God alone save them. Lessons must be learnt from the nearest country like Bhutan where health and education services are absolutely free, and the most highly paid services in the country. This is done as a matter of policy for the country’s development: attract the most meritorious persons to work in these sectors and subject them to regular review of their performances.

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