India is becoming chronically illChronic diseases such as diabetes, cancer and heart disease are on the rise in India. But for many Indians the care is unaffordable -. Often they know nothing about these diseases.
By Martina Merten Published: 24.01.2014, 05:02
Every day, around 100 patients come to Dr. Naresh Trehan (2.v.l.) to the conversation about. Treatment of their disease.v.l. Talk about. treatment of their disease.
The entrance hall of Medanta, the Medicity, is more reminiscent of a hotel lobby than one of India's largest specialty clinics. Patients sit comfortably on shiny white benches.
One floor up – in the waiting room of Dr. Naresh Trehan – may the wealthy of his patients enjoy coffee and business magazines.
Security personnel standing outside the door of Trehan's consulting room direct masses of patients into his treatment room every five minutes.
The founder and director of the private clinic, arguably India's most renowned heart specialist, sees up to 100 patients a day from all over the country. Many of them had to save for a long time to be able to afford to talk to Trehan.
The heart specialist has strong words when it comes to the rapid increase in chronic diseases in India: "The future looks bleak." What he means by this: Chronic diseases are responsible for more than every second death in India.
Heart disease accounts for 24 percent of deaths caused by non-communicable diseases (NCDs), followed by cancer (six percent) and diabetes (two percent), according to India's health ministry. 60 percent of these deaths occur before the age of 70. year of life.
Is the government sitting idly by?
The government, Trehan believes, does not know how to deal with this growing number of patients. The majority of Indians cannot afford appointments or care in specialist clinics like his.
But what the Medanta founder finds even worse is that a large proportion of Indians have no idea what a chronic disease is or how to treat one. "Indian government must finally start educating people about chronic diseases", says Trehan.
In an interview with Anshu Prakash, Secretary, Ministry of Health, India, it seems that the government is already doing a lot to fight NCDs. "For many years, we have been aware of the problem", says Prakash.
Since 2010, the government has been working on a national program to prevent and control cancer, diabetes, cardiovascular disease and strokes.
Even before that, he said, there had been all sorts of pilot programs across the country.
The size of India alone – the country is the second largest in the world with a population of 1.2 billion – seems to make the fight against NCDs more difficult.
And there's something else Prakash notes a while into the conversation: "Many Indians we try to reach through our education and prevention campaigns are in denial about their illnesses."
Ignorance about chronic diseases
Professor Anoop Misra had to go through a similar experience. In 2011, the diabetologist founded a facility called Fortis C-Doc in Delhi – an education, training and treatment center around metabolic diseases.
In previous years, the director of the National Diabetes Foundation of India had repeatedly noticed that many specialties were not united under one roof, patients had long distances to travel and doctors were not sufficiently informed about diabetes as a disease. At the same time, Misra observed how his colleagues Prakash. Trehan the ignorance of many Indians in connection with chronic diseases.
About 100 patients now come to the facility every day, 80 percent of them diabetics. However, Misra admits that treatment at Fortis C-Doc is only available to a small minority of wealthy Indians.
In his defense, he immediately adds that prices here are still much lower than in the West. "And good treatment is just more expensive."
More stress after moving to the city
In India, 455 million people lived on less than $1.25 a day in 2005. In 2015, despite the rapid growth of the middle class, it will be. Of the country's steady economic growth for years, 313 million Indians are still his.
The percentage of illnesses untreated for financial reasons is 28 percent in rural areas and 20 percent in urban areas, according to the World Health Organization.
If certain chronic diseases were spreading only among middle-class or wealthy Indians, this might not be a problem. "But chronic diseases are now reaching the poor as well", Knows Dr. Usha Shrivastata, head of the National Diabetes, Obesity and Cholesterol Foundation of India.
The reasons: More and more Indians are migrating from the countryside to the cities, where they are exposed to increased stress, the cost of living is higher and therefore they live in slum areas.
At the same time, much of the food they can afford in cities is bad food – high in fat, salt, the wrong carbohydrates, adds Dr. Rajan Sankar, manager of the nongovernmental organization Global Alliance for Improved Nutrition (GAIN).
"Many Indians are so busy with the challenges of everyday life that the topic of healthy food is often overlooked", says Sankar.
Detectable increase in Safdarganj
Since 2002, the GAIN organization has been working with local partners to educate people about healthy food.
The focus is mainly on women with young children. Because, says Sankar, it's ultimately the women who cook the food and look after the children at home, not the men.
In Safdarganj, by Indian standards, with 30.000 population a small town in Uttar Pradesh, observed Dr. Derendra Verma indeed an increase in chronic diseases.
The doctor's small, inconspicuous private clinic is located on the right-hand side of the unpaved, dirty main street of the village; 40-50 patients visit him every day.
"Many of my patients suffer from high blood prere, diabetes or even depression.", says Verma. If he compares the frequency with that of ten years ago, an increase is discernible, he has observed.
Verma can't give more specifics. He hardly has time to deal with documenting patient data and their disease histories because of the many patients who visit his small dispensary every day and are in need, he says.
Money for health tears big hole in family coffers
Questioning looks: people in front of the health station in Museypur.
The data become even more vague in Museypur village, a few kilometers from Safdarganj. At the entrance to the village there is a small infirmary. It includes a few wooden beds with raffia mats.
What the patients in Museypur are suffering from, Dr. Pankay Kumar does not say so exactly. The doctor only comes by now and then to take care of the villagers. Anything else is not financially worthwhile for him.
When asked about non-communicable diseases, Kumar just shakes his head. "Diabetes I don't think is that common, but we don't have a way to check that either." There is not enough money for a laboratory.
The people who live and mostly die in Museypur belong to the stratum in India who have no more than one U.S. dollar a day to live on. Every expenditure on health care makes a big hole in the family budget.
If there is an emergency in Museypur, Kumar says, it can take days before transport to the nearest major hospital is available. And even these larger county hospitals are usually poorly equipped. Thousands of patients from surrounding villages flock there every day.
Doctors are lacking everywhere
In all these villages – as the annual report of the WHO country office in Delhi states – the problems in small health stations like the one in Museypur are the same: there is a lack of clean drinking water, in many stations there is not even electricity for hours, let alone a computer.
Even in larger hospitals, there are on average only 0.6 beds per 1,000 inhabitants – in Germany there are eight beds. There is also a lack of doctors everywhere, especially in rural areas.
In rural areas, statistically, there are only 0.39 doctors available to 1000 residents, compared to 1.3 doctors in urban areas. Statistically, Germany has more than three times as many doctors per 1000 inhabitants.
The young and old villagers standing outside the health clinic in Museypur watching doctor Dr. Pankay Kumar questions answered, look at the doctor with questioning looks.
What he answers and what he talks about, they do not understand. Just as they would not understand that in Delhi, on the outskirts of the city, there is a clinic whose entrance area resembles that of a five-star hotel and where coffee and magazines are served.