One of the foremost challenges faced by India during the ongoing pandemic has been the lack of quality, affordable public healthcare. This was especially visible in the Northeast of India, where quality healthcare remains a dream for most even during regular times. And the state of Mizoram epitomises this situation, particularly it’s southern portion.
Just one government doctor caters to 50,473 people in Mizoram’s southernmost region.
To put this in context, the World Bank recommends a doctor patient ratio of one doctor for every one thousand people. In developed nations, this number is higher, although even lesser developed countries like Cuba have much higher numbers at an average of 8.4 doctors per 1000 people. According to this report, India has achieved the World Bank figures, but of course this number changes from region to region.
In South Mizoram, that figure currently stands at 0.00002 at a time when the entire world is witnessing a pandemic, and when the number of COVID-19 cases continue to remain steady in the state.
While the number of doctors might be astonishingly low, it is not as if health facilities do not exist, at least on paper. Mizoram’s Lawngtlai district is made up of two Sixth Scheduled Tribal areas — the Lai and Chakma Autonomous District Councils (LADC and CADC) and altogether, there are 46 health facilities, including the lone district hospital, one Church-run hospital, a single Community health centre, five Primary Health Centres (PHC) and 37 sub-centres in the district.
While most of these facilities are concentrated in the district’s northern and eastern regions where the main towns are located, the southern regions are left in the care of the lone doctor at the Bungtlang South PHC, which falls within the LADC.
The Bungtlang South PHC and the 12 sub-centres under its jurisdiction cater to 91 villages in all: 45 of these are within the LADC, while 46 are within the CADC.
This has been the situation for years, but has been aggravated by the COVID-19 pandemic (which has brought the lack of medical staff to statewide attention) and the monsoon (which has left many areas cut off, at least by road).
All this has led to demands that a newly-built PHC at Longpuighat village be made functional — short-hand for deploying doctors, nurses and other staff to man it.
In July, just as India was seeing a slowing down in daily COVID cases, Longpuighat, which falls within the CADC, saw a surge in COVID-19 cases. On July 7, 170 people tested positive for the virus. On July 9, a further 140 tested positive. The monthly total eventually reached 335.
In all, COVID-19 cases have been detected in about 20 villages under the Bungtlang South PHC during the pandemic’s second wave in Mizoram, and several had to be declared containment zones.
This surge prompted a letter jointly signed by the Village Council, Zonal Young Chakma Association, Chakma Students’ Union and Mahila Samiti at Longpuighat to ask state Health Minister Dr. R Lalthangliana to deploy a medical team to Longpuighat.
In response, a nurse was posted at Longpuighat to temporarily aid the response to the pandemic while a doctor monitored patients remotely.
As the virus started to ebb, the same set of community leaders at Longpuighat wrote a second letter to the state health minister on August 4, asking that the PHC there be made functional as soon as possible.
In that letter, they spelt out how Longpuighat is one of the larger villages within the CADC and how the PHC would cater to people living in half of the council’s 20 seats, home to almost 26,000 people of whom 70-80 percent live below the poverty line.
It wasn’t just COVID-19 that people were being left to fend for themselves against, they wrote, but a host of other illnesses such as malaria, typhoid, dysentery and others typically brought on by the rainy season.
PHC demand at Longpuighat is two decades old
As early as 2002, then MLA Nirupam Chakma attempted to move a resolution in the State Assembly demanding a 10-bedded PHC be set-up. The resolution subsequently lapsed and the issue remained forgotten for almost two decades.
During last year’s budget session in March, MLA Nihar Kanti Chakma asked when the PHC building could be officially opened. The health minister’s reply was that some electrical connections still had to be made, and that it would be opened as soon as a doctor and other staff are posted and staff quarters built.
In April last year, soon after the first case of COVID-19 was reported in Mizoram, a meeting of state, CADC officials and doctors discussed the need to set up a PHC at Longpuighat.
Eventually, when the pandemic reached the area a month ago, it was the Bungtlang South PHC and it’s lone doctor, Dr Johny Lalmuanpuia Tlau, that had to cater to the area.
Longpuighat is just 50-odd kilometers from Bungtlang South. But bad roads in the monsoon make it no less than a five-hour drive, and accessible only by 4-wheel-drive vehicles.
Even then, slushy roads often mean passengers have to get down and push, said Dr Tlau, who has been posted in the area since he joined the state’s health service in 2019.
But all roads are not so lucky. Currently, Longpuighat and CADC headquarters Chawngte/Kamalanagar are connected only by boat. So is Longpuighat and Parva, the southern end of Mizoram often referred to as the tri-junction between Bangladesh, India and Myanmar.
Bad roads between Bungtlang South and Longpuighat and between Longpuighat and peripheral villages where COVID-19 tests have to be conducted are only one of the problems, though. Another major problem has been the lack of quarantine and makeshift treatment facilities. Houses in the area are mostly small, Dr Tlau said, making home isolation difficult.
And these far-flung areas also have a problem in terms of public perception on health interventions, as evidenced by the letter by community leaders to the state’s Health Minister.
“…after having suffered from covid-19 diseases, the local people have realized that the way of life to live involves relief from other dangerous diseases like Malaria, Typhoid, Jaundice, common cough, stomach pain etc.,” they wrote.
Dr Zothanpari Chhakchhuak, the medical superintendent at Lawngtlai District Hospital, concurred that one of the major problems in the area, particularly in and around Longpuighat, is a general reluctance to follow Covid-appropriate behaviour, such as wearing masks.
“With new state guidelines allowing for asymptomatic patients to be discharged after 10 days, most simply said they didn’t have symptoms,” she said.
To add to the woes, the medical staff at Bungtlang South late last month and earlier this month also contracted COVID-19, possibly from their travels into the CADC part of their jurisdiction.
Among them were Dr Tlau himself, a laboratory technician, an accountant and a data-entry operator’s family also contracted the virus. The lone nurse posted at Longpuighat also had to be quarantined after one of her assistants contracted the virus.
Dr Zothanpari Chhakchhuak added, “Dr Tlau had in fact just recovered from Malaria when he returned to duty and contracted COVID-19.”
She worries for the young doctor and his team, and said the sooner the PHC at Longpuighat opens the better for everyone, including medical staff.
“If the [Longpuighatah PHC] opens, there is no doubt our health indicators will go up,” she said.
Lawngtlai district, alongwith its neighbor Siaha have one of the worst health indicators in Mizoram. The latest National Family Health Survey (NFHS) shows Lawngtlai district has the worst rank in at least 12 indicators among Mizoram’s districts.
Politics takes over medical ‘emergencies’ in South Mizoram
Even in the neighbouring district of Lunglei, it seems that attempts to address the lack of medical facilities, especially those related to COVID-19, have hit several roadblocks.
In April 2020, just as India was coming to grips with the global pandemic, Congress legislator Zodintluanga donated an RT-PCR machine to the district. The machine that was meant to ease people’s lives by making testing easier for South Mizoram residents, however, caused a political furore in the region.
According to news reports, the ruling government asserted that there was no requirement for RT-PCR in the Lunglei district due to the availability of a TrueNat machine and the unavailability of a laboratory facility for the RT-PCR. Opposition parties slammed the ruling party saying political visions are prioritised above the public.
RT-PCR for Chhimbial, an organisation that was formed for demanding the establishment of the RT-PCR, filed a PIL at the Gauhati High Court, Aizawl Bench. This case is still ongoing.
According to court proceedings, on June 14, the Health Department Secretary issued an order “stating that the competent authority was pleased to detail a team of experts to visit Lunglei, to explore the feasibility for establishment of a make-shift Covid-19 RT-PCR diagnostic laboratory at Civil Hospital, Lunglei, to cater to the needs of the 4 districts of south Mizoram and to fulfil the indication made to that effect by the Minister, Health & Family Welfare Deptt., during early March 2020.”
The government said a team of experts investigated an RT-PCR laboratory in the hospital. The team of experts reported that three vacant rooms would be available as a laboratory and the costs, including procuring an RT-PCR machine, would come up to Rs 1 crore. It was also reported in the press release that the Health Minister had on several occasions reached out to the Indian Council of Medical Research, New Delhi for installation of an RT-PCR laboratory in Lunglei Civil Hospital.
After that, the issue remained dormant and forgotten for all intents and purposes.
On May 7, 2021, the Director of the Hospital & Medical Education, Mizoram, wrote to the Medical Superintendent, Civil Hospital Lunglei, where he requested the installation of the RT-PCR machine at the earliest at the Microbiology department in Lunglei.
Following this, on June 2, another DIPR statement reported that a Detailed Project Report for a laboratory block of Rs. 7.8 crore was submitted to the North Eastern Council. The case was filed based on the reasoning that an RT-PCR laboratory has not been set up only because the machine was gifted by an opposition MLA. They argued that as per the letter from the Director of Hospital & Medical Education, the RT-PCR machine can be installed at the Microbiology department in Civil Hospital.
The Secretary of the organisation, RT-PCR for Chhimbial, L. H Lalzarzoliana told EastMojo, “Ever since we filed a PIL, the government has started taking initiatives for the laboratory building. Even then, it does not seem like the government plans to set up the laboratory, rather, it seems like they are looking for ways to avoid the installation of the RT-PCR machine.”
“When experts came to investigate the site in 2020, they had provided arrangements on how an existing vacant room can be used for the RT-PCR laboratory. We have asked for the documents of the investigation through RTI but have not received any documents till now,” he said.
RT-PCR for Chhimbal stated the urgency of the need for an RT-PCR machine in the district, saying, “There is extreme urgency of testing as there have been numerous backlogs waiting for test results. The people who are in home quarantine due to contact tracing can no longer wait for the outcome of the sanction of Rs 7.8 crore. It is the opinion of the people at southern parts of the state that the respondents are making undue advantage of this critical period of extreme urgency to avail such a scheme from NEC while the Expert Team felt that the rooms can be renovated with minimum expenditure.”
Many NGOs have spoken up on the issue from the district, including the Lunglei Thalai Pawl (LTP), Mizo Upa Pawl (MUP), Mizo Hmeichhe Insuihkhawm Pawl (MHIP), Mizo Zirlai Pawl (MZP), Chhimbial Chhantu (CBC) and Zoram Driver’s Union (ZDU). These organisations submitted a “signature campaign” to the DC, Lunglei, for the establishment of the RT-PCR on June 29, 2020.
Finally, earlier this month, sources in the ruling party Mizo National Front (MNF) said Mizoram is likely to get two mobile vans equipped with RT-PCR facilities from the Centre.
Lok Sabha Member C. Lalrosanga and newly-appointed Officer on Special Duty (OSD) to the chief minister Rosangzuala on Friday called on Union Health Minister Mansukh Mandaviya in Delhi during which the Union minister informed them that the Centre will provide two RT-PCR mobile van (Infectious Disease Diagnostic Laboratory, I – LAB), the sources said.
However, it is going to be some time before the state, especially South Mizoram, will see an increase in the number of doctors.
(With inputs from Kimi Colney)
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