A group of children and their families ate the food served at a football match. All of them had a stomach upset within a few hours, and most of them had to be hospitalised within a day or two. Those hospitalised included children, a maid, a guard, a bus driver and a conductor, the grandparents of a child, an accompanying doctor and a representative of the organiser of the match. Most of them took more than a week to recover, during which no intervention worked. The children suffered pain, loose motions and vomiting. There were other associated problems in some patients, ranging from kidney- to liver-related complications. After a few days it was apparent that this was no ordinary stomach upset and no ordinary bug had caused it. But none of the hospitals where the patients were admitted reported this unusual bacteria or unusual stomach upset case to the health authorities. The hospitals ranged from large to small and private, charity to government.
It turned out the bug was resistant to eight out of 10 commonly used antibiotics. It also turned out the bug was in the mayonnaise sandwiches supplied by a local bakery, which had sourced them from a supplier, who had prepared them at home. A visit to the supplier revealed that the sandwiches had been prepared in the bathroom, probably because that was the only place where water was available.
The police were informed but no action was taken. The bakery continued to sell the same sandwiches sourced from the same supplier. The original supplier continued his business in the same manner. Complaints to the health authorities elicited no response either. The police accused the parents of not caring for their children because they did not report the problem on the first day itself!
This episode took place in the country's capital, New Delhi. Its hospitals are among the country's best. A complaint is gathering dust at the Kalkaji police station. Some bureaucrat in the health ministry of the Delhi government might not even have read the file pertaining to the episode lying in front of him. By pure chance the bug was sensitive to two drugs. One of these days, there would be another bug that would not be sensitive to any antibiotic. And we would not be prepared to face it - our authorities would be too busy doing other things.
There are two issues at play here -hygienic food production and adequate health care response.
The Delhi government is sensitive to food quality; that is why it has come up with two different alternatives to the problem of preparing cheap, hygienic food. Subsidised hygienic food production by the government was first proposed. This was rejected as it would have impacted the livelihood of a large number of poor vendors. This was followed by an even more impractical solution - banning roadside food production.
The solution to the problem of preparing cheap, hygienic food is actually not that complex, as is the solution to most problems. Once the complaint was lodged with the police, it should have asked the food department to look into it rather than carry out a sham of an investigation. On the basis of the complaint, the food department should have investigated the source of the food. The bakery should have been held responsible and fined/challaned or its licence suspended. No one needed to be banned or jailed; bad judgement on the part of the bakery had to be followed by appropriate punishment. This would have sent the right message to other bakers - maintain basic hygiene - and incentivised them to act more responsibly. In other words, bakers are responsible for their suppliers meeting basic standards. This would have been a far simpler solution and would not have required a police investigation or an FIR. It would also have matched the right skill set to solve the problem: food inspectors are the right people to investigate food-related problems, not the police.
On the public health side, hospitals should, in the normal course of their functioning, report unusual cases to the health department. They normally do not, because the procedures take too much effort and time. They get away without reporting because the health department does not monitor or punish them. Had the hospitals in question reported the case to the health department, it would have collated the doctors' experiences in treating those children for future reference.
Increasingly, most departments in central and state governments are not performing their basic functions. This might be because they are overburdened, as many claim, or because they are not punished for non-performance, as many others believe. Whatever be the reason, the normal response today in India is for the complainant to attempt to get an FIR registered. But that does not work as well, for the police are as stretched and dysfunctional, and are not even sensitive to public health problems.
So why do we do things in such complex ways in India? Because we believe that the government can do better than the market. The food department and the police are incapable of monitoring food preparation across the value chain and therefore, have effectively abdicated responsibility. The market would be far better at monitoring if only the government worked with it rather than against it. While consumers can and do monitor retailers, the retailer can also monitor the supplier and so on. Of course, all that it required is that when a consumer files a complaint, the department should respond quickly. This system of G2M or government-to-market interface is far easier to implement than banning roadside food production or providing cheap food for all through the public sector or suchlike solutions.
Meanwhile, in that particular toilet in a Delhi slum, the antibiotic-resistant superbug is still residing and mayonnaise sandwiches are still being prepared there. It will mutate, as bacteria always do, and god only knows for how long it will remain sensitive to those two antibiotics.
The author is an economist
Disclaimer: These are personal views of the writer. They do not necessarily reflect the opinion of www.business-standard.com or the Business Standard newspaper
