Monday, 30th October 2017

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Debilitated in Delhi

Chikungunya and the AAP

By Mukul Kesavan
  • Published 16.09.16

We succumbed without a fight - my wife, my sister-in-law, my daughter and I - to chikungunya. It's an undignified affliction that sounds like a Haryanvi word for a chicken's virtues and feels like a preview of old age. For those of you who haven't had the pleasure, from the end-user's perspective (since we are all consumers now), chikungunya is fever plus arthritis. The fever goes away but the joint pains linger as the virus makes a leisured and seemingly random tour of your moving parts.

This is the stage that doctors with their gift for detached understatement classify as 'sub-acute', the weeks (months?) when you can't reverse your car because it hurts too much to swivel your head, or hold anything because the joint that works your opposable thumb shrieks when you try, when you learn not to casually slide off the sofa on to the floor because you mightn't be able to get up again, when you get used to thinking of your body as a drained battery that doesn't fully recharge any more.

I don't know if the incidence of chikungunya in Delhi qualifies as an 'epidemic' but the state of my household, news reports and other anecdotal evidence certainly suggest an unprecedented rate of infection. This, however, is not the view of the Delhi government. Addressing a press conference on the thirteenth of this month, its health minister, Satyendar Jain, declared that there was no 'outbreak' of chikungunya in the nation's capital and that the panic about the disease had been created by the media. He cited the hundreds of vacant beds available in the hospitals run by the Delhi government as a kind of proof that the scale of vector-borne (mosquito relayed) infections had been greatly exaggerated by the press.

One explanation for the health minister's statements could be that he believes the figures put out by the municipal corporation. The latest figure supplied by this source put the number of chikungunya infections at just over a thousand. This is an absurdly low figure which tells us nothing about the actual incidence of chikungunya. A report in the Hindu pointed out that just three of Delhi's 45 government hospitals had reported more confirmed cases of the disease than the total number reported by the civic bodies. The AIIMS, Safdarjung Hospital and the Lok Nayak Hospital had together recorded more than 1700 confirmed cases of chikungunya.

When you consider that this figure doesn't account for the cases registered by the other 42 government hospitals, or those tested and treated by private pathological laboratories, private hospitals and general practitioners, it becomes apparent that the several jurisdictions that allegedly govern Delhi - municipal, state and Central - either don't know what the scale of the problem is or don't care.

The main reason why the incidence of chikungunya is grossly under-reported is that most government hospitals don't have the facilities to do the necessary blood tests and the private pathology labs that can test for it are too expensive for the vast majority of patients. Typically, the chikungunya test costs between two to three thousand rupees. Many general practitioners don't see the point of even recommending the test because testing positive for the disease makes no difference to the course of treatment. Unlike malaria there are no specific drugs for chikungunya: the best a doctor can do is prescribe paracetamol and plenty of fluids and he doesn't need a test to do that.

A general practitioner treating feverish patients will often prescribe affordable procedures that test for typhoid and malaria. If the tests turn out to be positive, he can administer the appropriate drugs; if they don't, he can carry on prescribing Crocin and rehydration. This means that most patients who suffer from chikungunya never have their condition confirmed and consequently public health authorities don't have the figures to estimate the magnitude of the problem.

In the absence of reliable data, reportage becomes crucial. Sarah Hafeez of the Indian Express had a novel and illuminating take on the impact of mosquito-borne diseases on Delhi's working class population. In an exemplary piece of reporting, she interviewed PWD project managers, construction workers, factory workers in west Delhi's industrial townships, trade union officials and sanitary workers to build a picture of how chikungunya had affected Delhi's labour force.

She discovered that there had been a 30 per cent drop in the availability of construction workers on the PWD's construction sites because of viral fevers, nearly 20 per cent of Mayapuri's factory workers were ill, which had seriously affected productivity and profits and finally, thousands of safai karmacharis, forced to work in insanitary, mosquito-infested locations without protective clothing, gloves or masks, were incapacitated by chikungunya and other vector-borne diseases.

Delhi's health minister and its PWD minister are the same person, the aforementioned Satyendar Jain. His political technique in defence of both portfolios is one of stout denial. Wearing his PWD hat, he denied that any construction projects had been delayed owing to a shortage of workers during a special session of the Delhi assembly. This despite the fact that sources in the PWD had confirmed to Hafeez that major repairs to flyovers, overbridges and elevated roads had been postponed or delayed because ill construction workers had abandoned worksites to return to their villages in search of cheaper care and treatment.

Historically, infectious diseases force political elites into constructive action if only because they disrupt economic activity and don't discriminate between the poor and the rich. The colonial State in India, for example, was notoriously frugal when it came to investment in health infrastructure, but the economic consequences of epidemics and the vulnerability of European civilians and soldiers to these diseases forced it to invest in preventive policies like vaccination out of a sense of self-preservation.

The republican states that succeeded the raj, have had notable successes in this area. India managed through concerted action and persistence to eradicate both small pox and polio. Most people my age were vaccinated every year in school and I vividly remember the public camps organized by the State to administer oral polio drops when my children were infants. More recently, the World Health Organization declared Sri Lanka to be free of malaria. There hasn't been a single case reported in Sri Lanka over the last three years, a remarkable achievement for a country that used to report half a million cases a year. Given that Sri Lanka's population of 20 million is more or less the same as Delhi's, the contrast between the Sri Lankan government's systematic campaign against malaria and the Delhi government's willed blindness to chikungunya isn't just embarrassing, it's grotesque.

Arvind Kejriwal and his colleagues have offered anyone who cares to listen a three part defence. One, the Central government acting through the lieutenant governor of Delhi has made it impossible for the AAP government to function. Two, sanitation and preventive public health are operationally under the jurisdiction of the municipal corporations of Delhi which are run by the Bharatiya Janata Party, so chikungunya is actually the BJP's baby. And three - this is the Satyendar Jain gambit - the chikungunya epidemic has been invented by a panic-mongering media.

This is not a persuasive argument. If the third assertion - that there has, in fact, been no notable 'outbreak' of chikungunya - is true, the first two claims are irrelevant. And as someone still feeling his joints, I'm unsympathetic to the idea that my symptoms are a figment of some journalist's overheated imagination. For a party that once touted mohalla clinics as its proudest welfare achievement, Satyendar Jain's state of denial is symbolic of the purblind arrogance that hollows out a populist movement, even one as original and disruptive as the Aam Aadmi Party, once it achieves political office.