Nadda says will work towards increasing PG seats in medical colleges but silent on when and how

Union health minister J P Nadda was in Bhubaneswar on March 26 to launch the national Rotavirus vaccine in government healthcare system in four states. During his day-long events in the state capital of Odisha, I got the chance to ask some questions on important issues pertaining to the health sector at the sidelines of some events. The minister reluctant to answer much queries however responded to some of the queries.

(Published in Orissa POST, Bhubaneswar on March 27, 2016)

By-Manish Kumar  

1.  Many parts of the country suffer from dearth of qualified doctors. Do you have any plan to increase PG seats in medical education to tackle the issue?

Nadda: We will be taking steps to address the issue. We will look into the problem. However it will be a premature move to comment on the issue now as there is not enough material now to talk on the issue and elaborate. When we will have enough plans to elaborate we will discuss. Right now I cannot comment as I don’t have enough plans in hands to talk in detail.

2. International funding to the National AIDS Control Programme has declined. Will it have any impact on the overall programme.

Nadda: No. The government is committed to work into this regard to issue the programme runs smoothly and the people living with HIV can get government support.

3. But is Centre capable enough now to ensure HIV treatment through government hospitals in the country despite funding challenge?

Nadda: Yes. The Centre has meanwhile extended the facilities of the government to benefit more number of people living with HIV. Now with the support of the Central government people having the CD count of between 420-500 can also avail the government support. With this move, we have included 1 lakh more people living with HIV in the last one year into government treatment. The whole funding issues will also be taken care of.

4. The Mental Health Care Bill 2013 and the HIV & AIDS (Prevention and Control) Bill 2014 are still pending in the parliament. What is the reason for the pendency of these two crucial bills?

Nadda: We are committed to pass these bills. We will be moving it forward to pass. However I cannot comment on the issues in haste as I am unable to elaborate during the short span of time during my visit to the city.

5. Any specific reason? Is the opposition not cooperating?

Nadda: I cannot answer all questions after my exit from programmes during my walk with you. I will look into this.

6. Available data suggests that AIIMS, Bhubaneswar received the largest funds from the Centre out of the all the new AIIMS in the country. Any specific reason?

Nadda: No. The allocation of funds to the different All India Institute of Medical Sciences (AIIMS) spread in different parts of the country by the Centre is based on the work plane furnished. So the funding was made purely on the available work plan.

7. It has been heard that there could be some administrative changes at AIIMS, Bhubaneswar and the director may be changed. What is the reality?  

Nadda: The decision of appointment of director of AIIMS in the country is done by a pre-determined process. There is a selection committee in place and such decisions are taken by them and the Centre has little role to play into this matter.

Public broadcasters in India often influenced by ruling govt, says veteran BBC journalist Mark Tully

Veteran BBC journalist and author William Mark Tully is a household name in Indian journalism. In a freewheeling chat on the sidelines of the Kalinga Lit Fest in the city, Tully talks on his time in Orissa, his views on Indian media and what is keeping him busy at the moment. Excerpts from an interview with Manish Kumar...

You have travelled extensively in India. What impression you have of Orissa in your mind?

Tully: I visited Orissa for the first time in 1944, and found it to be rich in spirituality, culture and heritage. Later, I often visited Orissa during my time as a BBC journalist. I find Orissa very beautiful and before coming to the lit fest, I travelled to Puri to spend some time there.

You have worked for a long time in India. How do you think it has changed over the years?
Tully: India is a dynamic and beautiful country. It has undergone many changes in the last few decades, especially since the abolishment of the licence raj. People’s aspirations have changed drastically and they are no longer satisfied with being where they were some years back, and that is a very positive sign. The government too needs to support such aspirations in order to develop as a nation.

How was your experience of participating in the lit fest?
Tully: This is a new concept but a very innovative and welcome one. I enjoyed the lit fest here where we had a lot of fruitful discussions. I also got a chance to listen to several good speakers from diverse fields. However, lit fests should not be confined only to deliberations. Discussions and brainstorming sessions should yield
tangible outcomes.

You have become fairly conversant in Hindi. Was it tough picking up the language?
Tully: It is all thanks to the wonderful people here. I learnt the basics of the language over the years by talking to people in Hindi. They made it easier for me.

Do you think Public broadcasters in India express independent views?
Tully: In India, Public broadcasters are largely affected by whichever regime is in power. Broadcasters work according to their orders, and this is something that hampers the independency of news. I remember an incident when one of my friends working on a state broadcasting unit had to wait for government orders to broadcast the news of the assassination of former PM Indira Gandhi. However, there are still some
bright points.

Do you think India has the potential to come up with a global channel like BBC?
Tully: It will be a Herculean task. It requires a lot of set-ups and infrastructure. India can come up with a BBC-like channel only if adequate support from authorities is garnered. It will require government support. But then how impartial and independent it will be is a question to ponder over.

What are your future plans?
Tully: I have already crossed 80 years, but my journey has not stopped. I am working on a new book. This would be a compilation of short fictional stories inspired from the lives of common people in India.

Casteism is never alien to Indian universities

By-Manish Kumar

In 2011, as a young journalist who recently jumped onto the bandwagon of this dynamic profession I was thrilled to write a piece on a categorical casteist practice rampant across the medical colleges of Bihar. Buoyed by the inside information I acquired through my old friends and bolstered by one of my seniors to work passionately for the story I went ahead.

I was then posted in Deccan Herald, Bangalore, one of the most reputed English newspapers from the state. After compiling all sorts of cases of discrimination on the basis of caste which was popularly christened as ‘phylum’ in those medical colleges I decided to call up the authorities who are entrusted to safeguard the interests of the students and take care of college affairs.

My first call to the Dean of a government medical college at Muzaffarpur and his arrogant reply flummoxed me. Here is the short conversation we had over phone from Bangalore.

Me: Hello Sir. This is Manish from Deccan Herald Newspaper. I am calling from Bangalore. I am working on a story and wanted to talk to you over an issue relating to your college.

Dean: Ji Bola Jaye (Yes. Please tell)

Me: Sir. I have heard that casteist practices are rampant in your medical college. Students there are divided on caste lines and many cases of discrimination are reported from your centre?

Dean: Hame is Vishay me kuch nahi bolna hai. Aise kijiye aap mukhyamantri se baat kar lijiye (I am not going to answer on the issue. You better talk to the chief minister on the issue)

Me: Ok sir. I will surely talk to Nitish Kumar but are you denying that such activities occur at your premises?

Dean: ping..ping..ping..(hung up)

This was the Dean of Sri Krishna Medical College and Hospital, Muzaffarpur. After my initial research I also came to know that this was the same college where caste kitchens used to exist few years back which meant that different kitchens used to cook food only for one particular caste. The pre-colonial chasm between high and lower caste was already pre-existing in the state and was often bolstered and provoked by the different political parties in the state which often try to exploit the issue to convert it into votes.

However, only casteist grouping and caste kitchens are not the only issue affecting medical colleges in Bihar. Cases of caste discrimination is said to be rampant in premier government medical colleges like-Patna Medical College, Nalanda Medial College, Darbhanga Medical College and others.

A dalit boy was reported to have committed suicide at Patna Medical College when he was pressurized to give more money as contribution for Saraswati Puja event. However it never became a national story. 

However let’s return to the focus point. In general practice and accepted norms, a new comer in any medical college in Bihar is often asked their ‘phylum’ (caste) when he/she joins the medical profession. They are later brainwashed to remain adhered to their phylum to maintain the sanctity of their caste.

The grouping starts in the first year itself. Seniors of your caste will ask you to keep yourself away from the members of other castes of the opposite sex. They will also tell to take help only from seniors of your caste. Moreover, more astonishingly, there will be ‘caste parties’ often called as ‘phylum parties’ where all the same caste students from 1^st year MBBS to last year will flock at a restaurant in Patna and will celebrate.

But point to ponder what they actually celebrate? Sovereignty of their caste? Discuss about how bad other castes are? Stereotyping them? Paving a way for more discrimination in the coming days and how to keep the casteist practice alive?

Such retrogressive practices are evident at a time when many are into the cyberspace expressing freely about freedom of speech, how our PM is a charismatic one, how to mow down people having counter views. At a time when many of them claim that our country is developing but do they ever bother how their activities are still pulling the society backward? Also such practices blindly followed by students and youths from the state is really worrisome.

However the menace is never alien to medical colleges of Bihar. Such practices are reportedly existent in colleges and universities in Uttar Pradesh. Astonishingly, a panel called- Thorat Committee which studied presence of castesist thoughts at premier institutions like AIIMS and IIMs also found out that the next generation high-fi doctors and managers are also not untouched by the casteist thought.

The case of suicide of a dalit scholar at University of Hyderabad has sparked the debate of casteism in educational institutions and media is analyzing and debating in detail, a good sign for the media at least. Otherwise many newsmen choose to avoid such regular practices which are now ok for them.

At a latest speech one of the most rational and senior journalists, Ravish Kumar at TISS gave a food for thought. During his speech he said, “If people are not questioning casteist practices aren’t they doing casteism. Aren’t they casteist if they accept the existing discriminatory norms? At a time when people are writing their biography on Twitter and boasting about development, dalits are forced to wear helmets while riding on horses during their weeding in India. What an irony this is?”  

Time to ponder, analyse and debate …

I never imagined my Dark Is Beautiful campaign can change lives of many, says Nandita

Actress, director and social activist Nandita Das has worked in over 30 feature films in 10 different languages. As an actress, she is known for her performances in ‘Fire’, ‘Earth’, ‘Bawandar’, ‘Kannathil Muthamittal’, ‘Azhagi’ and ‘Before The Rains’. ‘Firaaq’, her directorial debut feature film, premiered at the Toronto Film Festival in 2008, and has travelled to over 50 festivals, winning over 20 awards. She has been on the jury of the Cannes Film Festival twice and has been awarded the Chevalier of the Ordre des Arts et des Lettres by the French government. In an interview with Manish Kumar & Debdutta Mohanty, Das dwells on the relevance of the ‘Dark is Beautiful’ campaign and why Article 377 should be scrapped outright. Excerpts:

You are the face of the ‘Dark Is Beautiful’ campaign that has gone viral on social media. Has the campaign been able to challenge the general bias in favour of a fair skin?

The campaign was started by a group named Women of Worth in 2009 and I became a part of it in 2013. ‘Dark is Beautiful’ was the brainchild of Kavita Emmanuel who is founder and director of the group. I supported the campaign and was chosen to be its face. As it gained momentum, many women started speaking out against complexion-related discrimination. I received countless emails from women who said they have to face humiliation because they are dark. These women said the campaign has empowered them.

Does Bollywood prefer fair actresses?

Of course! In the industry everyone prefers a fair actress. A dark actress’ skin tone is made a shade or two lighter in the make-up room. There are dark male actors around but it is difficult to find a female actor with a wheatish complexion. I have never believed that in order to be a good actor one has to be fair. I am fortunate that my parents never discussed my complexion. The film industry experience, however, was different. There have been instances of directors and camerapersons telling me that I should make my skin tone lighter to suit certain characters I was playing. If even an actor like me gets to hear all this, I wonder what millions of other dark women are subjected to. The make-up man boasts he is an expert in making people look fair. Bollywood movies have always glorified fair skin.

Do you believe the campaign has had an impact on the advertisement agencies and the film industry?

The ad agencies have definitely become more responsible, as can be evinced from the current fairness cream ads on TV. Advertising Standards Council of India of India has prescribed certain norms that advertisement makers have to abide by. As far as the film industry is concerned, the campaign has had small impact. Many film stars still endorse fairness creams. However, there are a few who have put their foot down when asked to appear in a fairness cream ad. By doing so they have set an example.

You have always championed the rights of the LGBT community. Have you also taken part in protests denouncing Article 377?

Yes. We still have that archaic law in the Indian Penal Code which even the British do not have. Why should we follow that? These are human rights that we are talking about. Every person has the right to free expression. The Constitution has granted equal rights to all citizens of the country. Article 377 is discriminatory in nature.

You have worked in many women-centric films. Do you think more such films need to be made?

Many films have had women as protagonists. From old films like ‘Mirch Masala’, ‘Chasme Badoor’ and the Shyam Benegal films to recent ones like ‘Page 3’ and ‘Queen’, we have seen some strong women characters. The film industry is changing with new writers and new stories coming in, so I think there is more scope today for women actors to play different characters. People are now exposed to world cinema and mindsets are slowly changing. We have a long way to go, though.

Do you think the rise of social media has helped women put forward their problems before the public?

I suppose social media has made it easier for all of us to voice our opinions. It has definitely increased the space for discussion and different opinions and perspectives are competing for attention on social media. Someone should do a serious research on whether social media has empowered women and enabled them to voice their opinions. I think it has made a difference.

Intolerance today is an issue that the entire nation is discussing. What is your take on the issue?

The entire nation cannot be painted with the same brush. India is a glorious example of unity in diversity and its people are not just tolerant but also respect different faiths and cultures. We are an intrinsically pluralist society. Certain sections of our society are intolerant and even bigoted but that was true in different periods of Indian history. Unfortunately, those who are intolerant and abusive are getting not only more space in the media these days but also backing by powerful politicians. Over the past few months there have been incidences of intolerance in different parts of the country. These should be condemned in the harshest possible terms.

The Central government is mulling revamping the censor board under the leadership of Shyam Benegal. What are your expectations?

I think better norms in the film certification process will come into place under the guidance of Shyam Benegal who is a sensible filmmaker. A team of members cannot decide what the people of the country may want to see. Let the people see and decide for themselves what is right and wrong. The censor board may not agree with the views expressed in certain films but that does not mean it should reject those outright. For instance, many U-rated films have offended my sensibilities and I have found them objectionable on different grounds. I think it’s a matter of perspective. What’s right in your eyes may be wrong in mine. Filmmakers should censor their own work before putting them out for public consumption.

You have acted in films made in different regional languages. Even good films made in the regional languages don’t get to become as popular as those made in Bollywood. Why?

First of all I do not believe in the distinction between regional and mainstream Hindi films. Films are all a part of cinema. There are only good and bad films. Films made in languages other than Hindi do not have enough marketing muscle unlike the mainstream commercial films. I have worked in very good films which have powerful and meaningful stories but they do not reach a wider audience as they are poorly marketed. Due to this reason many people do not get to watch these films. Economy interferes with art.

What are your future plans?

I am working on a film based on the life of Saadat Hasan Manto, a famous Pakistani writer whose heart yearned for Bombay where he spent many years of his life. He was tried several times during the British raj and also in Pakistan for obscenity. Salman Rushdie has called him the greatest writer of south Asia. His story is very relevant as he fought for freedom of expression and struggled to go beyond national and religious identities. What intrigues me is that there is a Mantoiyat in all of us — the part that wants to be free-spirited and outspoken. Manto’s fight for freedom of expression and against orthodoxy is truly inspirational.

Forest dwellers in Ganjam village under threat of losing their rights

By-Manish Kumar

Icchapur (Ganjam): On a cold morning of Sunday (December 14^th) I embarked on a four-hour road journey to Icchapur village under Polsara block in Ganjam district from Bhubaneswar. I had earlier heard about the threat the villagers have been facing from local authorities. 

The people living in the remote village have now received letters from the local authorities saying the villagers don’t have any rights over the local forest area and all their claims of land rights have been rejected by them. Saddened by the whole affairs the villagers have now roped in their hopes on some local NGOs and community leaders to avert the possible plights the villagers may face in the near future.

However a personal visit to the site was an enlightening one and an eye opener. I believe deliberations and discussions on forest rights, adivasis, poor and other dimensions in an urban area in a big hotel do not hold much significance if you cannot realize the gravity of any situation which could be achieved more effectively if you personally see the problems in hand.

A visit to the small remote village will reveal that at a time when the country is pushing to be into the United Nations Security Council, many villagers and parts of the country is still living in a pre-independent state like situation. The maverick fact about the remote village that can flummox many visitors is the literacy levels of the villagers. Most of the villagers are either illiterate or if literate have not studied beyond standard V.

Under such circumstances, the people eye on the literates from the village and on some activists, journalists and other social workers who can raise their issues to the concerned authorities and help their voices and plights to be heard. 

Once I and some of my friends entered the village we were garlanded and given flowers nicely tied up by the villagers, mostly STs, dalits and other traditional forest dwellers.  It was a very different kind of feeling as for the first time I received such a warm welcome by a group of people with hopes in their eyes.

A local meeting of aggrieved villagers was organized to ponder over the conundrum and to eke out future course of actions to avert the damages. During the meeting it came to the fore that the local government has sent them letters in January 2015 rejecting their claims of forest rights. The villagers were meanwhile asked to respond if they want to object.

However, the villagers reported that they received such letters only after the time given to them to respond exhausted. Literate persons from the village say that letters relating to land rights never reach the persons through post man but it rather gets delivered by some office person working in local offices.

Later the interpretation of the letter takes time as they search for literate persons to read it and paraphrase it. However thumb impressions on receipt letters are often taken from them and they give it easily without understanding the content of the letter.

A 5^th pass villager from the village said, “We also never see any official coming to the village and talk directly to us or rather demonstrate the consequences and their plans. However we can see local MLAs, gram panchayat leaders and other coming to our village during election. But no one come to help us at the time we need it.”

The Forest Rights Act, 2006 mandates verification of the local forest land by the forest rights committee, role of gram sabhas, role of elders in verifying the facts of their existence in the area for more than 3 decades and others. However most of them according to the villagers seemed to be a Utopian job.

A septuagenarian villager told me that his family has been living in the village for the last 7 decades but the letter has been threatening their occupational and economical rights. They also fear that the authorities may do the same thing with their village too anytime, bolstered with the dearth of literacy and awareness levels of the local villagers and nonexistent knowledge of the villagers about the legislation made to safeguard their interests.

The historic Forest Rights Act,(FRA) 2006 came in the country after the 60 years of India’s independence and was a landmark constitutional reform. It was a result of a long struggle of the Adivasis (ST) and Other Traditional Forest Dwellers (OTFD) depending upon the forest for their basic livelihood needs.

The draft act placed in the Parliament in 2005 was only for STs. But later it was realized in the Joint Parliamentary Committee (JPC) in 2006 that along with the STs, there are large number of Other Traditional Forest dwellers, which comprise a number of Dalit population living in and around the forest and depending upon it for their very survival.

Accordingly, the name of the act was also changed and it became “The Scheduled Tribe and Other Traditional Forest Dwellers (Recognition) of Forest Rights Act, 2006 and OTFDs other than tribals are also recognized rights over forest.

Ghasiram Panda, Programme Manager of ActionAid, Bhubaneswar who is well versed with forest right issues told me, “FRA is very clear in respect of providing forest rights to OTFD along with STs. Ironically most of the states including Orissa has shown step-motherly attitudes towards the OTFDs while there is no such conflicts at the village levels in the grounds. Despite possession of forest land by the OTFDs, verification of that by FRC and recommendation of Gram Sabhas, submission of evidences certifying three generations by the elders and gram sabha, the other executive bodies Sub-Divisional Level Committee (SDLCs) and District Level Committee (DLCs) at the district are arbitrarily rejecting the claims of the OTFDs. “

He also added, “It is because the officials at higher level have issued informal direction to these bodies (SDLCs and DLCs) on not to approve the claims of OTFDs.  In Orissa, only in very few districts have very minimal claims on IFR of OTFDs have been sporadically recognized while in rest of the districts OTFDs have filed IFR claims, shown to have been approved by concerned Gram Sabhas but their claims have been arbitrarily rejected by the SDLCs.”

The Act and Rules make responsible the sub divisional committee to provide evidence and necessary support. The amended rules in 2012 also clearly spell out that no one can reject the claim except GramSabha. However in this case the Subdivisional level committee of Bhanjanagar has arbitrarily rejected the claims of OTFDs which is a clear violation of FRA.

 

Orissa struggles to tackle HIV, progm suffers

By-Manish Kumar

Bhubaneswar, Dec 1: The National AIDS Control Programme launched after the first Human Immuno Deficiency Virus (HIV) case was detected 29 years ago to ameliorate the condition of the victims, but the social stigma continues to humiliate the group till now.

Investigations by this newspaper have brought to focus several dark sides of the healthcare institutions which instead of helping people living with HIV are actually turning their lives miserable. Many discriminatory incidences in renowned government hospitals, which are often the hope for many HIV people for their treatment, have surfaced.

Although clear norms are set by the National AIDS Control Organisation (NACO) to ensure extreme confidentiality of people living with HIV, government hospitals like SCB Medical College and Hospital seem to be blatantly flouting guidelines.

According to NACO, doctors are advised to write ‘immuno compromised’ on prescriptions instead of HIV positive to shield the patient’s HIV status but such norms are ignored.

I got hold of  a prescription issued by SCB Medical College, Cuttack, (in the picture) to an HIV positive patient, which discloses his HIV status. The prescription states ‘HIV positive diagnosed since 2008’. Ironically, the doctor prescribes medicines for purchase from medicine stores without consideration for consequences such as embarrassment the patient may undergo.

Sheetal Mohanty (name changed), an HIV positive person, said, “Many doctors and hospitals write clearly on prescriptions as ‘‘HIV positive patient’’. We show this to medicine shops where we have to face strange gestures. Our relatives unaware of our medical condition may find the prescription and consequently, we stand a threat of social stigma.”

Like Sheetal there are others who have faced such situations. However, people working in the field say there are problems galore for people living with HIV when they confront strange attitude from even healthcare professionals.

Activists working in this sector say despite projects to eradicate discrimination at hospitals such issues continue to persist.

Sushmita Sahoo, project coordinator of Kalinga network for people living with HIV, told me “We take persons with HIV to Capital Hospital or SCB Medical College for treatment. The doctors do not deny that they would not operate such patients. They promise to try their best but pass the buck on to someone else. Often doctors at Capital Hospital refer patients to SCB and doctors at SCB also redirect such patients to Capital Hospital. In such cases HIV positive people are left to run from pillar to post for treatment.”  

The problem arises when the doctors have to conduct surgical operations although general treatment at clinics is not an issue, said Sahoo, adding not all doctors are alike. Some operate on HIV positive persons but there are many who are reluctant to operate on them.   

When contacted, SCB Medical College superintendent PK Rath said, “We will look into the matter. A minimum protocol must be followed. I will advise the errant doctors to ensure they don’t write such things on prescriptions in future.” 

AIDS Control Programme under threat in Orissa

Despite the National AIDS Control Programme (NACP) having been operational in the state since 1997, there are problems galore on the way of its interventions these days. The problems are expected to grow due to the structural changes the agencies associated with NACP are undergoing.

In March 2015, the Centre slashed National AIDS Control Organisation’s (NACO) budget by 22 per cent. The move followed withdrawal of NACO’s autonomy and its merger with the central health ministry. Worsening NACO’s woes, many international organisations also withdrew their financial support to NACP. The impacts of such changes are now felt in the states, including Orissa.

NACO has been spending most of its funds in prevention and awareness strategies implemented by its state-level organisations such as Orissa State AIDS Control Society (OSACS). The most popular programmes of OSACS – distribution of free condoms and awareness campaigns through ground-level health volunteers – are now being hit by funds crunch and the changes formulated at the central levels.

  

“We signed a contract with OSACS last year to work in targeted intervention programmes to demonstrate among high-risk groups and the masses how to prevent HIV infection from spreading. But we hardly get free condoms from OSACS, and the financial support is also negligible. But, undeterred, many of us still work only with the aid of some private agencies and NGOs,” said Meera Parida, chairperson of All Orissa Third Gender Association.

“With scanty funds to pay ground-level health workers – who often comprise female sex workers, the third gender and others earlier engaged in sex work – many of them are found returning to their earlier unsafe trades,” added Parida.

Loknath Mishra, a veteran activist from Gopalpur under Ganjam district who has been working in this sector for the last 21 years, said: “The whole programme is now under threat. There are cases where such health workers have not been paid for six months. So they have no option but to quit as health workers.”

“In the most affected district of Ganjam, there are around 3,500 villages. OSACS has reached just 100 of them. Only increased awareness and education can prevent the rise in HIV infection, but such programmes now face threats,” added Mishra, who has founded a shelter for children with HIV in Gopalpur.

Officials at OSACS also express helplessness. “The recent changes have posed significant threats to the whole programme. The funds that NACO earlier sanctioned directly to the state units are now routed through the state government treasury, and we have to apply to get the funds from there. We are able to get just our salaries from there, but our programmes at the ground level do get affected,” said an OSACS official requesting anonymity.

Under, NACP, now in its fourth phase, the new rules mandate that the state AIDS societies would get 25 per cent of the funds from the state government, unlike earlier when they got the whole funds directly from NACO. Experts are wary of the new funding channel facing bureaucratic hassles. Besides, though activists have been urging a merger of National Health Mission with NACP since 2012, no steps have been taken in that direction yet. 

Experts warn that a gradual crippling of the programme and laxity of the authorities concerned, if left unchecked, could lead to cases of infection increasing rapidly. Such fears have proven true in countries like Philippines, they say.  

However, state health secretary Arti Ahuja assured during a public function Tuesday that the state government would extend full support for successful execution of NACP in Orissa so that there is a reduction of infection, stigma and deaths to zero levels. 

Pvt clinics, testing centres biggest defaulters:

Banners and advertisements outside private clinics claiming treatment for HIV and diagnostic centres offering HIV testing facilities may attract many visitors. These claims for treatment of viral disease, however, turn out to be hoax when it comes to following the prescribed norms of National AIDS Control Organisation (NACO). The national body seeks to ensure uniformity in prevention and treatment strategies of the viral disease.

According to experts, private clinics and diagnostic centres have little to offer to people living with HIV. Many working in the field of HIV advocacy and control believe private clinics/diagnostic centres are doing more harm than good in controlling the disease.

Such treatment facilities go against the norms set for regulated HIV testing. NACO prescribes pre and post testing counselling in cases of HIV test done at diagnostic centres, which is non-existent in some private clinics. Consent of patient for HIV testing was not taken by such private hospitals.

The fact has been vindicated by many who have opted for private facilities.

“I was suffering from a kidney stone ailment and the doctor told me to go for surgery for which he asked me to undergo several tests including HIV. However, a pre-counselling was never done in this case. I was surprised when I donated blood recently. The blood bank held a comprehensive couselling over HIV,” said a regular blood donor here.

Experts suggested dependence on trusted ART centres for HIV treatment. Rewati Raman Rahul, a public health expert, said, “ART clinics are most reliable medical centres for HIV treatment. Doctors there are trained by concerned authorities on changed combination of drugs and are well-informed about the latest development in the field,”

An HIV activist said, “Some private clinics use preliminary HIV testing facilities like ELISA, which could yield faulty results. Confirmatory tests are done at government hospitals to get only confirmed cases. The mandatory prophylaxis and treatment norms to prevent transmission of virus from HIV positive women to their children are not being adhered to in private hospitals.”

NACO has issued such guidelines in 2010 to prevent transmission of virus from pregnant women to their children. The Orissa State AIDS Control Society (OSACS)  also affirms that private players have little role in HIV treatment.

Talking to me, OSACS additional project director Chandrika Das said, “I advise people living with HIV to consult trusted ART centres at government hospitals. Counselling and other services are available at government hospitals through blood banks and integrated counselling and testing centres (ICTCs) which have reliable testing and counselling systems for the needy.”    

Such claims have been vindicated by some state AIDS societies. According to a study conducted by Delhi state AIDS control society in 2014, private hospitals and nursing homes were violating the NACO norms.

The study said, “Private hospitals declare an individual as HIV positive on the basis of a single HIV rapid antibody test, whereas the National ICTC guidelines recommend a series of rapid antibody HIV tests to declare a person HIV infected.”

Viral load test still a utopian dream in Orissa

Notwithstanding 36, 617 HIV cases in the state and a 9 per cent share in the country in new infections, the crucial viral load test for people living with HIV is still not available in the coastal state. The test which helps in calculating the amount of HIV available in the blood of the affected persons often helps in administering the right combination of drugs to directly attack the causative organism of any disease rather than giving symptomatic treatment in the absence of a key blood report.

“Saddened by the affairs, people living with HIV are now forced to move to Kolkata which is the nearest centre where testing is done. Many poor people never bother to go for such crucial tests as the whole exercise of travelling to a different state and other expenditures are not affordable,” said Prabhasini Mishra, chairperson of Kalinga Network of People Living with HIV which is active in Khurda district.

Experts opine that absence of such reports cascades the woes of people living with HIV. Dr Rewati Raman Rahul, a public health expert, said, “In the absence of a report, doctors give medicines on guess. Many a time, the root cause, which could be higher viral load, is not targeted, making the given treatment futile.”

Unfortunately, test centres managed by National AIDS Control Organization (NACO) number only six in the whole country. The Centre has no plan to open new units citing high cost of establishment of testing units.

I recently filed an RTI with the Central government asking if they have any plan to open such a centre in Orissa. The reply is still awaited. Meanwhile, the Central health and family welfare ministry has forwarded the RTI plea to NACO.

It is not only a lack of viral load testing centres in the state. Other problems relating to drugs and testing are also galore. According to people working in this field, managing existing infrastructure is still a problem.

“Once in a year we get news about shortage of drugs at ART centres, although counselors and doctors ask HIV persons never to miss the medicines as such things can cause drug resistance. Also at least once or twice, the CD4 blood testing machines get defunct in hospitals affecting the treatment cycle,” said Sushmita Sahoo, who works with the Vihaan Project which works to control the disease besides working towards advocacy, legal aid and interventions in cases of medical and social stigma.

The defunct machines of CD4 testing tools are also reported from Ganjam district which accounts for 35% of the total HIV cases in the state. Nevertheless, activists working in the field said counseling services at government hospitals have been satisfactory and yielded good response including persuading high risk groups to undergo treatment.

The change makers in Orissa

Working from a small office in a three-storied building in Nayapalli, Biswa Bhushan Pattnaik, project director of SAATHI (Solidarity & Action Against the HIV Infection in India), has been working with ‘Project Pahchaan’ which has set a goal to generate awareness among high risk groups about the viral disease and ways to prevent its infection.

“We work with high risk groups like transgenders, hijra community and men who have sex with other men. Members of such risky groups need proper education about the hazards. We have been screening films on such issues, having direct communication and other means to change the attitude of such groups and also the society,” Pattnaik told me.

Such training and communication, according to Pattnaik, help bring attitudinal change in society. “Often, we go to villages where we screen films. We elicit reactions of villagers after the film show. We have seen change in their mindset. We ask simple questions like ‘‘would you buy a vegetable from a vendor who is HIV positive.”     

Another inspiring person I spoke to was Sushmita Sahoo who has been working with the Kalinga Network of People Living with HIV. She is associated with people living with HIV. Her work involves direct advocacy of issues related to them with the government and healthcare institutions. With the support of her organisation, she has been intervening in cases of social stigma and discrimination.

When asked if she gets perturbed seeing the overall fear among people towards the disease, she said, “Not at all. I have been working with HIV positive people for long. I do share food, living space and often engage with them in counselling. We exhort them to stick to their treatment cycle. I believe, like doctors treating them also need to be friendly with them.”

Like people working in Bhubaneswar, there are many in other parts of the state who have dedicated a big part of their life fighting for the rights of people living with HIV. Loknath Mishra, a veteran fighting for HIV rights from Gopalpur in Ganjam district for the past 21 years, is the founder of a children’s shelter in Gopalpur which works for kids living with HIV. The shelter was set up with the support of erstwhile Ganjam collector V Kartekeyan Pandian, now private secretary to the chief minister.

Overwhelmed by the support Mishra and his institution have been providing for kids with HIV, he said, “All kids living in the shelter home are attending schools. It would have been difficult for them to go to schools had they resided in their locality with HIV status. We fought for the issue and ensured the kids live a dignified life without discrimination. They play with each other after school and adequate care has been taken for them.”

Besides private interventions, Orissa government seems to have taken some measures to tackle HIV. The state is among the few in the country which covers people with HIV under some pension scheme. The state government covers people with HIV under its Madhu Babu Pension Yojana.  

Besides private interventions, Orissa government seems to have taken some measures to tackle HIV. The state is among the few in the country which covers people with HIV under some pension scheme. The state government covers people with HIV under its Madhu Babu Pension Yojana.