GOA HAS MANY HOSPITALS AND DOCTORS... AND SICK PEOPLE TOO
By Frederick Noronha

PANJIM, April 15: Goa has one of the most extensive health
systems in the country. But despite its impressive range of
health services, the people of the state remain a sickly lot.

"Despite (the widespread health network) it is pertinent to ask
why all Goans are not in good health?" asks a study on the State
of Goa's Health, to be discussed shortly at a meet. Compiled by
the Sangath Society, and supported by the Voluntary Health
Association of India (New Delhi), this independent study suggests
that "quality" of health-care is more important than "quantity".

This state boasts of higher training institutions for doctors,
dentists, pharmacists and nurses. It has four hospital beds for
every 100 persons, more than six times the Indian average. There
is more than one doctor for every thousand persons living in Goa,
which is twice the national average.

But the Sangath-VHAI report points to public health institutions
in a "sorry state" of disrepair of buildings, unhygienic
conditions of wards and toilets, rude staff, absent doctors, lack
of basic equipment and, above all, low staff morale.

Quality of health services are "uneven and often very poor" in
Goa, leading those who can afford it to take succor in Belgaum,
Manipal, Bangalore or Mumbai's hospitals. Goa still lacks its own
facilities to adequately treat cancer and heart disease.

Goa's public expenditure on health is declining as a proportion
of the state budget. Bulk of expenditure is on salaries, leaving
little for equipment, maintenance and infrastructure.  Private
doctors are meanwhile "ever willing" to oblige the pharmaceutical
industry with "generous prescriptions".

Oddly, Goa has only 1400 registered nurses -- less than the
number of doctors in the state. Goa has long had a thriving
indigenous medical system, which is not much appreciated now.

SUICIDES, NO COUNSELLING: In 1998, Goa was reported to have one
of the highest suicide rates in the country, which was also
rising fast. In 1995, nearly 250 people died in suicides, over
five times the number of deaths from malaria. Yet, barring a few
voluntary agencies, there are no community counselling services
in Goa. Most health practitioners are ignorant of the nature of
depression or its treatment.

Goa's population is also aging fast. This means chronic old-age
diseases like arthritis, dementias and heart disease could become
more common.

"Alcoholism is a major health issue which remains almost
completely ignored by the public health sector. There are no
reliable data on the scale of drinking problems in our community,
but ask anyone in a village about alcohol problems and you can be
sure that it will be cited as a major source of conflict and
improvishment in many families," adds the study.

Goa has one bar for every 40 male adults, and the second highest
per capita consumption of alcohol. Tobacco and alcohol are
"possibly the most important preventable causes of premature
death and disability in the community", yet politicians take a
"cynical attitude" only concerned with the potential income from
the vice-sector, says the study.

Despite intense political instability and an "unhappy portrayal
of poor governance", Goa's human development has shown
"considerable improvement" in fields such as literacy, infant
mortality , says the study

Economic indicators are "much stronger" in Goa, than in most
parts of India. Housing conditions are less crowded, the majority
have access to electricity, TV and radio, and newspapers.

Women's health in Goa is "much better than the Indian average".
But the literacy rates of women is still 15% less than that of
men, girls are much more likely than boys to drop-out of school,
and issue such as domestic violence are "increasingly being
highlighted as markers of persistent gender equality".

40% ANAEMIA: Anaemia during pregnancy is still very common (40%)
and nearly one-third of babies are born under-weight in Goa,
notes the study. Women from migrant labour communities,
unorganised working women, and sex-workers are "particularly
vulnerable to harassment, abuse and discrimination".

Goa's fertility levels have fallen below replacement levels. With
Kerala, this state has the highest proportion of elders in the
country, with seven per cent of its population being above sixty
years.

"Violence in families, most commonly directed at women and
children, remains another rarely reported crime. It is most often
perpetrated because of the prevailing attitudes towards women,"
says the Sangath-VHAI report.

Goa's children are healthier too than those elsewhere in India.
But there's no room for complacency: just over one half of
children with diarrhea were given oral rehydration. Basic
immunization, a health right, is not universal with about 75% of
children receiving all recommended vaccines.

Malnutrition among children has dipped to 10%, but nearly half of
children have some degree of iron-deficiency. Traditional child-
killers infectious diseases and malnutrition have become "less common".

CHILDREN'S WOES: But non-communicable diseases in childhood --
particularly developmental and behavioural problems -- have
become more visible, says the study. Developmental disorders
being diagnosed include autism, hyperactivity and specific
learning disabilities. There are "increasing reports" of child
abuse, specially emotional and physical abuse within the home.

Less than 10% of disabled children are in school.

CHILD ABUSE: Says the study: "Reports of sexual abuse by
paedophiles raise considerable debate on whether these are
isolated cases or represent a more systematic plot to target
vulnerable children on Goa's coastal areas. The truth is that
there is still far too little reliable information beyond the
individual and anecdotal reports, to be sure of the scale of the
problem."

It says even one child abused could be "one child too many".
Likewise, the study points to the "major myth" that child abuse
is largely perpetrated by foreigners. In the past 9 years, of 62
cases of child abuse reported, 59 were charge-sheeted, and 10
cases involved foreigners. In 37 cases, those involved were
relatives, friends or neighbours of the children.

Inspite of being more affluent, Goa has "very high" drop-out
rates. Nearly half of all children who enter school do not
complete their SSC exam; this rate rises to 80% for children from
scheduled castes and tribes.

Says the study: "There is an urgent need to examine the reasons
for this high rate of school drop-out, not only because the
reasons are likely to be very different for Goa than those for
poorer parts of India, but also because school completion is now
an essential requirement for most occupations."

Since the mid-eighties, malaria has become endemic in most
coastal areas of Goa. Worrying, the proportion of infections from
the more dangerous falciparum parasite has grown from just 3% to
34%, which is a hundred fold rise, between 1985 and 1998, says
the study.

It suggests that "resistance to chloroquine is now increasingly
apparent".

Road traffic accidents now account for one of the main causes of
death and disability in children and young people. "Many of our
roads have no pavements, there is no enforcement of any driving
laws, and many of the vehicles on our roads are not even road-
worthy," says the study.

REFUGEES IN GOA: Migrant labour communities "live like outsiders
or refugees in Goa". Adds the report: "The grotesque reality is
that although they build mansions and luxury hotels for local
residents, the workers defecate in open fields and their children
have no access to school or proper health services. Parochial
attitudes means that few Goans will stand up for the rights of
migrants..."

Mining, associated with considerable air pollution, means that
respiratory problems and diarrheas are among the commonest health
problems reported in mining areas. Tourism hikes prices of
staples such as fish, implying a reduction of protein intake for
poorer households.  

Massive garbage is being generated without any systematic
disposal policies in coastal Goa, and tourism has been associated
with alcohol-related problems too.

Goa is also "near the top of the league of Indian states in terms
of HIV positive rates".

Some of the suggestions put forth in this report include
partnerships between different sectors for improving health
services, a public health monitoring group, improving the quality
of health services, improving working conditions for non-medical
health workers, more support to the weak and marginalised, and
research & training.  


Frederick Noronha fred@vsnl.com  Ph 27 14 90 or 27 86 83