For a state as small as Delhi, the problems that the issue of jurisdiction brings are manifold. The civic bodies, led currently by the Bharatiya Janata Party, are trifurcated. The healthcare system falls under the respective region's Municipal Corporation of Delhi (MCD), the state government and the central government.
While sanitation and waste disposal are the responsibility of the civic bodies, the Public Works Department comes under the Aam Aadmi Party-led Delhi government. A recent High Court ruling said the Lieutenant Governor of Delhi is the "administrative" head of the state. What was supposed to clarify matters of jurisdiction and hierarchy seems to have started a cycle of systemic denial to accept responsibility and perhaps even a shade of petulance on the part of the political leadership.
The latest casualty of this no man's land is the dengue and chikungunya outbreak. As the issue becomes increasingly politicised and accusations are traded on national television, the average Delhi resident suffers debilitating blows from viral fevers.
Though the day is only just beginning for shopkeepers in north Delhi, doctors at the Hindu Rao hospital in Malka Ganj have already spent a few hours at the fever clinic. With widespread cases of dengue, chikungunya and even malaria this year, the fever clinic has attained a celebrity status of sorts, with everyone - from the parking attendant, janitors to passers-by - knowing its precise location. Whether for being under the glare of the media or for genuine planning, the clinic, unlike the rest of the hospital, is clean, well ventilated and odour-free. While park benches act as makeshift seating for patients, there seems to prevail a sense of calm that at once appears incongruous.
Deepak Kumar Das, senior doctor and in-charge of the fever clinic at Hindu Rao, mirrors this calm. "The situation is serious and there is an unprecedented spurt in the number of cases this year. But that does not mean we cannot handle the patient load," he says. His reassurance is based on the fact that so far, the hospital has not felt the need to trigger its "crisis" plan to manage beds in the wards. Currently, 140 beds are dedicated to dengue and chikungunya cases, in addition to another 140 beds across the seven wards in the hospital. In the event of a crisis, the hospital has decided to convert beds dedicated to the orthopedics, surgery and ophthalmology wards to handle the spill over of fever cases.
Unlike the verbal sparring that has taken over all of prime-time television, Das shrugs when asked about any administrative gaps that may be hampering the delivery of proper healthcare. "The government and civic authorities can only do so much. The actual change needs to come from people, especially when it comes to keeping their environment clean and mosquito-free."
MCD and the vector war
Like Das, many doctors believe that while political and administrative support is necessary, much of the work happens almost automatically given the systems in place. "That India is in an epidemic-zone is a reality. But we need to tackle this all through the year on a war footing and not just during the breeding season," says Das. This, many agree, is the biggest administrative failure in Delhi.
According to Shailender Singh, a South Delhi Municipal Corporation councillor, each agency has been doing its job, but community participation and cooperation is lacking. Considering that the Aedes aegypti - the mosquito that carries the dengue, chikungunya and malaria viruses - breeds in clean water, fogging and public sanitation efforts can only go so far. "Our officials risk their lives when they visit possible contamination sites. They have to deal with uncooperative residents who do not let them do their job. And yet, all we hear is that MCD is not doing its job."
For him, the problem lies in the fact that the political leadership in Delhi is "immature". "They made a hue and cry about the health secretary's absence. What they don't understand is that it is not the health secretary's job to visit hospitals." Instead, he says, MLAs and state Cabinet ministers can be more impactful in pulling up inefficient staff. "The message they send out should instill faith in residents rather than create panic and chaos and that's precisely what it does when you hear the government say that it is helpless," he says.
Several attempts made to reach Delhi Health Minister Satyendra Jain proved unfruitful. A senior party leader replied to a query saying that he would respond once things are "calmer".
A doctor with one of Delhi's leading private hospitals says that this shifting of blame leads to a complete breakdown of any coherent, collective strategy to tackle the viral strain. "They said the British used a 'divide and rule policy'. Here, we are all divided and no one is ruling. And everyone seems to be accusing private hospitals of wrongdoing," she says.
Ravinder Gupta, former mayor of North Delhi Municipal Corporation, agrees with this contention. "The extent of miscommunication is both appaling and counterproductive. This is not the first time the civic bodies are headed by a political party different from the state government. But even in [former Delhi chief minister] Shiela Dikshit's time, there used to be coordination committees to deal with these issues."
Gupta believes that whatever work is being done is eventually being carried out by the municipal corporations. While the Delhi government could create a smooth mechanism for the "odd-even" scheme and enlist the support of several volunteers, that vision seems to be completely missing in the case of the recent outbreak. "In a crisis situation like this, we see no support from [Arvind] Kejriwal. If he can protest and fight for his own government and officials, why not for the people of Delhi?"
Tackling it at the Mohalla level
For Rishi Bal, a doctor at the Aam Aadmi Mohalla Clinic in Todapur, the problem lies with doctors themselves. "Patients only go to hospitals when they do not trust their local physician. It is all about establishing a human connect and making sure your patients listen to you."
A seemingly simple approach seems to have worked well so far. About 70 to 80 cases of fever, some of which may be chikungunya or dengue, come to him every day. "Even if further tests reveal that it is indeed a vector-borne disease, the treatment would still entail rehydration and paracetamol. Why put the patient through unnecessary trauma and stress when the eventual treatment is the same?" This, he believes, also encourages patients to attend to a fever sooner and prevent it from reaching a critical stage.
But from an administrative perspective, this could lead to a misleading number of positive cases and underestimate the need for stringent measures. In most cases, the viral strain can only be detected once the fever has dissipated. "The faster RT-PCR (reverse transcription polymerase chain reaction) test is not available at most government facilities. Most patients would not want to come back to the hospital to just get tested when they are already weakened by the fever," explains Hindu Rao's Das.
Mukul Kesavan, a political commentator and historian, recently wrote in The Telegraph about Delhi government's "willed blindness" to chikungunya. "Jain's state of denial is symbolic of the purblind arrogance that hollows out a populist movement, even one as original and disruptive as the AAP, once it achieves political office."
For Sharda Devi, a 45-year-old resident of Burari waiting for treatment at the Lok Nayak Jai Prakash Narayan Hospital, the only grouse is with Kejriwal himself. "He asked for our faith, our trust. Where is he when we need him?" Her husband tries to reason with her. "But it's not his fault, it's the MCD's problem."
Between political allegiance, pragmatic administration and a cohesive strategy, Delhi residents can only hope that nature steps in with cooler temperatures and ends the breeding season - along with the debate.
