Comatose health institutions

The plague caught institutions everywhere completely inert. Only the Plague Surveillance Unit (PSU) in Bangalore - the last of its kind in the country - and its sub-unit at Kolar in Karnataka, were active during the 190s. Delhi's National Institute of Communicable Diseases (NICD) had the only group of epidemiologists and microbiologists poised to work out firefighting strategies. Calcutta, interestingly, which used to have a largish PSU with 120 employees, was left with 7, with 113 on deputation to other departments.

Running to catch up with every fresh outbreak, the NICD had no time to stay still. In the middle of this mess, the NICD's chief epidemiologist, S J Rehman, returned from Surat with fever and then stayed away from work for a fortnight.

A senior health ministry official eveals that retrenchment had reduced the number of doctors trained to deal with plague to a bare minimum: "For the past 2 decades, medical undergraduates have received no training in treating the plague." At the Surat Civil Hospital, the burden was put on a single microbiologist. New Delhi's All India Institute of Medical Sciences introduced a crash refresher course on the disease.

K K Aggarwal, president of the Delhi branch of the Indian Medical Association, adds, "We are still relying on information from the '40s and on drugs which were effective then." Even the NICD lacked the latest information. The country's plague focii map has not been revised since 1948. The government has proposed a National Plague Control Programme; the health ministry is now considering the wisdom of establishing a plague diagnostic unit at each district headquarter. But it's anyone's guess whether India's rusty health management system can take the pressure.