In an Exclusive Interview, Dr. Kuganathan Shares The Need For Systems in Disaster Relief Management

February 21, 2017, Chennai

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“It is pertinent to say that the non-communicable diseases are now on the increase. It is a paradigm shift!”
 

Dr Kuganathan is a practicing Public Health expert in India for the past 30 years. He has served as Director of Communicable Diseases Hospital in Chennai, and as Consultant for UNICEF, and Centre for Disease Control.


 

He has worked for several disaster relief and rehabilitation programmes across India and is presently a consultant at SIMS hospital, Chennai.

In an exclusive interview, Dr. Kuganathan shares with Marie Banu the need for systems in disaster relief management.

Your experience working for natural disasters as a health expert? 

I have worked for the disaster relief programme in Gujarat, the tsunami programme and the recent floods in Chennai. Our system seems to remain to be the same even after 69 years of independence. The government reacts to such situations instead of establishing a system to manage them. For instance, mobilizing people for food distribution or providing alternate accommodation for the affected people. There is a need to install an efficient system—to prevent and manage disasters.   

Over the years, there has been a change in mindsets amongst people. For the first time, Chennai youth were involved in flood relief. Sex workers from Kolkata contributed more than 10 lakhs for the flood relief programme. This is laudable! 

Chennai has over 1 crore population, out of with one-third of the people live in slums. But, what is our agenda to see that these people have better living conditions? Although the government provides 200 sq. ft houses for them, they continue to live in slums. This is because, as per WHO standards, the space for a family of six members is insufficient.  

We need to have an agenda for drinking water, removal of slums, and waste disposal.  Whenever I represented Chennai and while working for WHO, UNICEF, and Centre for disease control, Atlanta (CDC), I had always raised this issue. Removal of people living in slums is not a solution. We need to rehabilitate them instead. All of them work in the unorganized sector. We should ensure that they have better living conditions. If you wish to be humane, think of your neighbor and especially those living in slums. 

Can you tell us about the Chennai Corporation programme that focused on burial ground workers?

We have 130 burial grounds in Chennai where Vettiyans or the burial ground workers have been employed for over 250 years. While working with the Chennai Corporation I had the opportunity to interact with these Vettiyans, who are engaged in this occupation not out of choice but because they belong to a particular community. Almost everyone suffer from tuberculosis and their contribution to the family is poor. The government provides them with identity cards alone.

When I consulted their families, I learnt that they were unhappy as the household income was Low. During a meeting, the Corporation officials complained that the Vettiyans were fleecing. I mentioned that their livelihood depended on burying the dead, hence were not fleecing. 

I supported them because they were doing a good job and their voices were unheard.  I suggested to the Chennai Corporation to employ the Vettiyans and offer them a standardised payscale. Today, we have 200 of them on payroll. We also provided them with alternative work options like gardening or watchman or hospital worker or driver. 50 percent of them have now come out of this occupation. Chennai Corporation won a National Award for this effort and the press covered it well. 

About the youth living in slums. What efforts have been taken to rehabilitate them?

The plight of the youth living in slums is pitiable and most of the children are school dropouts. While working with CDC from 1992 to 1998 and in 2001, I mobilized the poor children from slums and conducted courses on: Nursing assistant, lab technician, and multi-purpose health assistant besides life skills.  We have trained over 2000 children so far and many are gainfully employed. 

We have 360 Corporation schools in Chennai, but most of them have inadequate students. This is because people prefer to educate their wards in English medium private schools. I suggested to the Chennai Corporation to start night schools and convert a few into residential schools for slum children. This will help us to teach them, correct their behavior, and also provide them with a safe place to stay. 

The Supreme Court has passed a law stating that any institution established for the purpose of education should not be used for any other income generating activity. Therefore, such initiatives will be beneficial for the children. 

About Amma Unavagam initiative?

The idea of Amma Unavagam was conceived by me after encountering a few women who were running food stalls on the road side. I had proposed to the government to start food canteens at affordable costs and employ women as it would ensure better health standards as well as secured employment for women at 300 rupees per day. The proposal was well received by our Honorable Chief Minister and the allocation of rice and dal was sanctioned by the Government. 

There was a lot of criticism initially, and when a team from Egypt and North India visited they stated that this programme was not cost effective. I told the Government of Tamil Nadu and the present Chief Minister that we should be interested in investing on people rather than focusing on revenue. Cost effectiveness counts on people’s health. We now have reduced rates of mortality and malnutrition. The life span for women has increased.  This is measurable!

We now have a request to launch such canteens in Government Colleges where there are more number of students cannot afford to have lunch. 

Can you tell us about the facilities available in our Government Hospital?

60 percent of the income earned by the poor people are spent in hospitals. We have about 20,000 patients visiting The Rajiv Gandhi Government General Hospital (GGH) in Chennai, but less than 150 doctors employed here. 

There is no separate structure to provide basic health care services. Ideally, this should be provided by Peripheral hospitals, but all the people visit GGH which is a tertiary care hospital. We need to have more doctors and nurses.

Although, the government has been providing good medical facilities, many choose to go to private hospitals. The Government sector has been playing a great role to a large section of our population as their services are offered free of cost.  

When compared to other states, Tamil Nadu is in a much better position as our health structure was derived during the 1950s.  The Primary Health Centre concept has been very efficient since then. I would always complement leaders like Shri Periyar and other Chief Ministers for creating awareness on health issues.  

What is the status of communicable and non-communicable diseases in our country?

I have played a big role in reducing communicable diseases in our State—especially cholera. Providing just treatment is not sufficient; it is important to reduce the sources. By providing pure drinking water, cholera can be controlled. 

In HIV, we created good awareness among the people, especially the pregnant women. While working with UNICEF as Offer-in-charge for Prevention of mother to child transfer of HIV Programme, we had organized doctors and social workers to counsel the expecting mothers. In a decade, we observed a drop in rates from 0.75 to 0.25 in one decade. 

It is pertinent to say that the non-communicable diseases are now on the increase. It is a paradigm shift! For instance, we have about 60 to 70,000 deaths out of which 20 percent is out of heart related diseases. We have more cases of Cancer, diabetes, and hypertension now. This requires a lot of lifestyle management.  


Marie Banu

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