Nuclear risk in India’s healthcare system

By Seema Sengupta

The death of 94 patients at Kolkata’s Advanced Medicare and Research Institute (AMRI) in one of history’s worst blaze on Dec. 9 has raised several uncomfortable questions about safety, security and efficacy of the healthcare model initiated by the Indian government.

Though India has achieved substantial progress in her vital health indicators over the years, productivity in the public health sector has registered a sharp decline. Lack of adequate funding forced the provincial and central governments to ride the public-private partnership (PPP) bandwagon in haste, resulting in a complete commercialization of the healthcare system.

Worst still, a country stranded halfway between capitalism and socialism virtually ensured a free-for-all in its health services. Private players were bestowed with prime land and infrastructure and allowed to operate the health facilities on their own terms without any oversight.

Since the monitoring mechanism and regulatory capacity of the government is extremely inadequate, the PPP model has turned into a complete farce. The abnormally high treatment cost emanating from the profit motive has effectively ensured that most of the medical facilities remain out of bounds for the economically backward sector. In fact India is perhaps the only nation on Earth where private agencies bear 82.3 percent of the total healthcare expenditure.

It is a pity that a country with half of its population afflicted by abject poverty makes an annual budgetary allocation of a meager 5 percent of its gross domestic product to healthcare as against the international average of 10 percent. Defying all ethics, the political class in India at the end of the day is unfortunately rooting for a survival-of-the-richest strategy.

For example, the government in West Bengal has decided to set up a high-end geriatric care clinic with private participation though there is an urgent necessity of universalizing this stream of medicine. Instead of developing a cost effective and comprehensive health policy for the aged from diverse economic and social background, the ruling dispensation is eyeing for the costly and speculative concept of regenerative medicine that the majority of patients cannot afford.

This craze for favoring private capital at all cost has nipped the very concept of public-private cooperation in the bud and simultaneously affected the intellectual and medical standards, thanks to the business strategy of making a fast buck.

Furthermore, the safety angle involved in the AMRI tragedy exposed the yawning gaps in India’s disaster management capacity. The raging flames that snuffed the life out of so many helpless and critically ill people are a manifestation of an acute administrative negligence that has become so common in India today.

Nobody really knows why despite all the big talk the country lacks the skill to effectively handle such a calamity where precious lives were lost out of panic and suffocation. The hospital was surprisingly permitted an unfettered run in spite of flouting all the stipulated safety norms.

There was no emergency evacuation plan and the alternative exit route simply did not exist. Neither was there any arrangement for providing free access to fire tenders nor did the fire alarms work properly. Water hydrant points and the smoke alarms malfunctioned at the time of the emergency. That the accident occurred at the annex building, housing the nuclear medicine department of a super specialty clinic-come-premier cancer research center is indeed a cause of great concern.

All the more so, because under the very glare of administrative focus this hospital was dumping inflammable and radioactive materials in the basement from where the fire originated. However small it might be, the provincial government does have a stake in AMRI with two of their nominees sitting on the hospital board and the director of medical education serving as the chairperson.

Perhaps this government link and the broad political connections emboldened the proprietors to violate safety codes without any retribution. It is now an open secret that one of the parliamentary lawmakers and a business magnate representing the Chief Minister’s party was very much a part of the consortium that established this medical facility. Incidentally, it is owned by a real estate baron-come-Communist Party member.

Finally, the amateurish nature of monitoring mechanism to enforce strict discipline among medical centers using radiopharmaceuticals under private aegis can pose a grave security risk. “Medical and dental facilities often have highly radioactive materials that could be stolen by terrorists for use in a dirty bomb," says Joseph Cirincione, an expert on proliferation of weapons of mass destruction (WMD) and terrorism.

Often hospitals and manufacturing facilities do not secure these materials adequately, points out Cirincione who is also a member of the U.S. Council on Foreign Relations. That his concern is not out of the mark can be gauged from the fact that the secretary of the Atomic Energy Regulatory Board of India has expressed serious concern about the safety of radioactive sources being used in radiotherapy and nuclear medicine departments of the city hospitals.

Therefore it is time for the government to pull up their socks before any non-state actor exploits this fallible healthcare mechanism in creating a nuclear catastrophe.

Miss Seema Sengupta is an independent journalist and contributing writer based in Kolkata, India. Contact her at sengupta.seema@gmail.com.