An epidemic of missing patients

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An epidemic of missing patients

The Times of India 10 September 2001, New Delhi - Kalpana Jain

NEW DELHI: At a missionary-run hospital in Patna, Dr Ravi Sahay has of late

started getting a steady trickle of HIV affected patients. But instead of

treating them, he turns them away for fear of contracting the virus. And he

believes other doctors need to be warned as well. He refers these patients to

a government-run set up, announcing their HIV positive status in red ink.

The patients are never seen again. Their records never show up in government

hospitals or even in the annual surveillance figures handed out by the National

AIDS Control Organisation for the past three years on the basis of the reports

collected from states. But these patients do appear as cold statistics in the

records of private testing centers. Just one centre in Patna, Sen Diagnostics,

has 615 confirmed cases. But these are not even considered by the government.

Officially, Bihar remains a low prevalence state, with only 44 reported cases.

Clearly the annual government count, which shows a gradual slowing down of the

rate of infection over three years - from 3.5 million in 1998 to 3.86 in 2000 -

is not measuring the epidemic accurately. Even if Bihar's example were to be

attributed to inefficient overall governance, serious gaps remain in the annual

surveillance exercise even in states with a strong administration.

Project director of the National AIDS Control Organisation, JVR Prasada Rao,

admits there are problems. " Pinpointed data from surveillance is not reliable.

But over a period of time a trend is discernible. You have to have validate

these with actual observations from a community nearby. "

So states are still trying to come up with an efficient system, even as

surveillance, conducted over a three-month period, from August 1 to October 31,

at 232 designated sites all over the country, forms the basis of future policy.

As of now, sample collection remains faulty even at the best of centers. Dr V.

Lakhshmi, at Nizam's Institute of Medical Sciences, Hyderabad, who is also a

regional coordinator for surveillance, agrees that some centres may not be able

to collect the requisite number of samples. For instance, Hospital in

Bangalore could get only half the requisite number of STD cases last year.

There are other problems as well: Kerala, there were no kits for testing at some

centres, even after the blood had been collected. These samples then had to be

thrown away. In Manipur, transportation of samples to testing sites is not easy.

Moreover, sample vials are not always properly sealed and their contents are

known to spill.

At several centres in Bihar, sample collection is barely a tenth of what is

required. Even the capital city of Patna collected only 46 samples from pregnant

women against the stipulated 400. Districts such as Darbhanga sent only 33

samples from STD patients, when the required number was 250.

(This is the third of a seven-part series which appears every Monday)

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Dr. Jagdish Harsh

François-Xavier Bagnoud (INDIA)

E-mail: jamworld@...

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