Childbirth has always been a source of fascination in Manipur with an aura of antiquity, both feared and revered, with babies often born in a ‘wangonshang’ or delivery hut.
With the coming of Western medicine and many babies having been born with Caesarean section, rather than through the same old fashioned route, it is no more a mystical or discomfiting event. Yet, many pregnant mothers die, though not as much as in the rich Western countries. Caesarean section is the best thing since sliced bread in saving maternal women’s lives during difficult childbirth.
Cost of saving maternal and other patients in Manipur should rise at par with the higher educational status of women and increasing standard of living, and as demands for medical care are skyrocketing. Inadequate hospital facilities are taking their toll in Imphal, while Imphal must also share its man-made Healthcare errors that impact 1 in every 10 patients around the world.
One 112 year old English lady in command of all her faculties, who broke her (r) hip after a fall last week, was seen on TV trying to walk after she had an emergency total hip replacement. It sound simple. There are tremendous preoperative, perioperative and postoperative care are involved, especially in a patient of this age.
Stringent care before any surgery is always very important, especially to prevent a clot in the leg veins such as elastic stockings, which can dislodge itself and travel up to the lung during and after the operation, when it can cause a blockage in the lung (pulmonary embolism), causing a condition like a heart attack (pulmonary infarct). It is usually the responsibility of the anaesthetist. When I first arrived in the UK, I got a job in anaesthetic and worked for 6 month. I had to see patients in the ward the night before, for fitness for surgery and premedications.
Naturally, while a lot of relatives in Manipur, swim their way through grief at the death of their loved ones in hospitals, let’s not forget the inconvenient truth that Manipur, like the rest of developing India, is a developing state. A developing country means a poor country without the definition jargon of being “a Low Human Development Index (HDI) or Low Gross National Income (GNI) ie a low standard of living”.
Though people in Imphal are as health conscious and knowledgeable about health and longevity matters, as those in Delhi, because of easy travels, media and the internet, lack of advances in modern technological facilities in Hospitals such as RIMS are part of the causes of many avoidable deaths.
Deaths in hospitals occur more in developing countries with transitional economies, despite the overwhelming UN control over deadly infectious diseases, such as measles and diarrhoea in babies; small pox, cholera, malaria, tuberculosis, typhoid, dysentery, tetanus and so on.
In rich countries, people die more from strokes (brain attacks), heart attacks and cancer – known as non-communicable diseases (NCD). They account for more than two-thirds of all deaths, but overall, by March 2015, deaths from NCD has dramatically dropped from 24 million to below 9 million each year with the introduction of more modern skills for prevention, diagnosis and treatment.
One of the impressive medical advances of the decade is the anti-smoking campaigns in Europe and America, including banning of smoking at work places, public places and hospitals. Smoking increases the risk of strokes, heart attacks and many cancers. Strokes due to blood clots can now be removed with prompt arrival in a general hospital.
Another advance is the treatment of heart attacks. With speed, a small clot in an artery can be busted with drugs. If the problem is due to building up of a clot in an artery, a tiny flexible tube called a stent can be guided from an artery in the groin or the forearm up into the heart, where it is used to prop open the vessel to allow blood to flow normally. If the blockage is two or three arteries, patients can have surgery to sew new vessels taken from elsewhere, into the heart to bypass diseased or blocked arteries.
In Manipur, while there are still threats of dying from infectious diseases, people are dying more from these NCD, mainly caused by undiagnosed high blood pressure (hypertension) as well as from diagnosed but inadequate treatment and ignorance that it is a lifelong treatment.
In a recent paper written by Rachel Nugent of the University of Washington, it was found that premature death rates from NCD in the developed world are now quite low but most of the deaths below age 70 occur in poor developing countries and the problem is accelerating. It is set to increase by 17% over the next 10 years. Manipuris have to watch out for it.
Tobacco that causes cancer is the single best killer worldwide. It will cause 10 million deaths by 2030. Research has shown that a person’s chances of getting cancer depends on a mishmash of their genes and their environment, but also certain aspects of their lives, many of which they can control.
Hypertension is another killer. About a billion people in the world suffer from hypertension, causing 9 million deaths. This is not a disease of the rich world. Manipur has a high incidence of high blood pressure that causes brain attack and heart attack.
In India, over 140 million are suffering from hypertension. According to Dr Sailesh Mohan, Associate Professor, Public Health Foundation of India, it is estimated that 20-40 percent of population in urban areas and 12-17 percent in rural areas have hypertension. A WHO estimate in 2008, suggested 33 percent of male and 30 percent of women older than 25 years had hypertension in India.
The trouble with hypertension worldwide, is that it is symptomless, not even a headache. Once diagnosed by chance, it needs quite some time to adjust medication to achieve a proper control. That means many visits to see a doctor. Besides, as it is asymptomatic ie patients do not feel anything they often stop taking medication, partly also because of its cost in poor states like Manipur.
Patients in Manipur, suffering from NCD, die because of lack of medical care and inadequate facilities in hospitals, as well as lack of skills of doctors. A few patients I know in India, have been living over 15 years after they had undergone coronary artery bypass graft (CABG) surgery at Apollo Hospital in Delhi. (The cost of surgery is about 1.5 to 2 lakh of rupees).
Likewise, though the maternal death rate ie death from pregnancy or its management occurs in developed countries, higher rates exist in developing countries like India. It is globally declining by 45 percent since 1990, still 800 women globally die every day. That is, one woman every two minutes – according to the United Nations Population Fund (UNPF) that estimated that 289,000 women died of pregnancy or childbirth related causes in 2013.
Almost 99 percent of all of these deaths occurred among poor people in developing countries and most could have been prevented – WHO experts said. The maternal mortality ratio in developing countries is 240 per 100 000 births versus 16 per 100 000 in developed countries.
Research has shown that approximately 80 per cent of maternal deaths could be averted if women had access to essential maternity and basic health-care services. This also highlights the importance of having skilled attendance at delivery. There is no mystery about why so many women are dying in Manipur while giving birth.
Death from NCD in Manipur is not new. It’s only that people in Manipur did not live long enough to die from them. And many women died during delivery because of complications as we did not have skilled health professionals of Western medicine.
Very few lucky people in the world, who escape death from infectious diseases or NCD, now die from old age at just over 80 when the body just switches life off as it tops the human life span.
There is no more mystery about death.
The writer is based in the UK