A Tale of Two Doctors and India's History of Hiding Its Diseases

A Bengal doctor has been suspended after he wrote a Facebook post on the dengue crisis. The case is similar to another doctor in Mumbai who was ‘raided’ for identifying totally-drug-resistant TB cases.

There have been reports of doctors not mentioning dengue on death certificates, even if that was what happened. Credit: StockSnap/pixabay

There have been reports of doctors not mentioning dengue on death certificates, even if that was what happened. Credit: StockSnap/pixabay

Sohini C. is a freelance journalist.

Dr Arunachal Dutta Choudhury, a doctor of general medicine at the Barasat District Hospital in West Bengal, likes to write in verse. His Facebook wall is filled with his Bengali poems. His favourite form is the end rhymes, and until last week, his poetry had an admiring but smallish following.

On November 8, however, the situation in the in-patient ward in his hospital moved him to write in prose. He published a long post in Bengali at 10:46 pm. The response was viral: the post was shared 925 times in a week (it was up under his own name until November 15 midnight; now, a friend has posted the same text on his timeline and it stands). On 11:40 am on November 10, he received a letter from the West Bengal Health and Family Department, suspending him until further notice. The grounds mentioned on the letter, Dr Choudhury says over the phone, are “misinterpretation to the public as well as derogatory [remarks] to the hospital administration as well as general health administration” (sic).

“Whatever I say is the truth, or else entirely a carnival,” Choudhury wrote in a long Facebook post titled ‘Hospital Journal’. “I was in charge of admissions at the hospital on 6 November, the hospital board carried my initials ADC. From 9 am (that day) to 9 am the next day, every admission made in the hospital would carry my initials on their hospital ticket… In the days when the number of patients admitted (in a day) was around 100, I knew it was a war. But today, when the number of patients admitted is near 500, I know the war is lost. The flood waters have entered, there is no option but to be carried away with the water.”

“The patients admitted lay not only on the floor of the medicine ward,” he continued, “but spread across the floors of the entire hospital. Wherever there was floor space, plastic sheets were spread out and patient lay. There was literally no place to stand…… On the death certificates, I write… Not dengue. There is no dengue in this state. Clever me … on the unfortunate dead man’s death certificate, I write fever with thrombocytopenia as the cause of death.”

Dr Choudhury’s Facebook post was the first time a doctor or public health professional had spoken about the the dengue situation in the state. It offered the first glimpse of the magnitude of the problem from the official side. Until this, there had only been the reports in newspapers, and Chief Minister Mamata Banerjee had dismissed these as speculation that was provoking panic. The numbers given by the government are of course vastly lower than by the news reports, and have also varied from day to day and person to person.

On October 12, Banerjee said 30 people had died of dengue in the state in the “past seven to eight months”. At a meeting of the ruling Trinamool Congress on October 25, she put the figure at 34 dead. And on October 30, at a press conference in the government headquarters in Nabanna, she said it was confirmed that 13 people had died of dengue while 27 others had reportedly died of the fever.

Dr Arunachal Dutta Choudhury. Source: Facebook

Dr Arunachal Dutta Choudhury. Source: Facebook

West Bengal’s director of health services, Biswa Ranjan Satpathi, said in an affidavit to the Calcutta High Court that 19 persons had died of dengue in the state over the year. This is the figure mentioned in the registry of the National Vector-Borne Disease Control Programme, where there is a note saying West Bengal’s figures have not been updated since October 4. Yet in the affidavit before the high court, Satpathi had submitted that there had been a spurt of of dengue cases beginning from the last week of September continuing into October. Then, on November 16, the West Bengal government submitted before the Calcutta high court that 38 people had died.

The chief minister, in a press conference, also appeared to criticise private healthcare facilities. “We have also received a report of 27 deaths which were caused by malaria, dengue or swine flu. These deaths occurred in private hospitals and we are yet to verify the reports,” she said. It appears to have functioned as an effective threat to doctors and pathology laboratories to suppress dengue, without any written circular on the matter. There are reports of doctors not mentioning dengue on death certificates. Doctors and pathology lab staffers refused to speak about the situation even on condition of anonymity.

… until Dr Choudhury wrote on his Facebook wall.

Over the past week, he has received thousands of friend requests and his posts have attracted a chorus of shares. “I shall now write only romantic poetry for my wife,” Dr Choudhury said over the phone. “My [hospital journal] post is still up but that’s it. My family has said this much is ok, no more. My mother is 89 and my father, 92. He is a cancer survivor. My time with him is stolen from destiny. I can’t afford to do anything to cut short this time.”

A national habit

Suppressing figures on dengue, and communicable diseases in general, is a national habit. An Al Jazeera investigation published in 2016 uncovered evidence that malaria figures had been manipulated in Odisha and Andhra Pradesh. In 2012, the Hindi film mogul Yash Chopra was said to have died of dengue. The BBC report on his death mentioned that “senior officials of the city municipal corporation are reviewing Chopra’s death to ‘ascertain the exact cause’”, though the hospital where he was admitted had identified dengue as the cause of death.

The former Left Front government in Bengal did this, too. A report in The Telegraph on September 6, 2005, said the government had acknowledged dengue belatedly, after it had been “shoved under the carpet as either viral fever or sometimes as mystery fever”. The terms “fevers of unknown origin” and “Calcutta fever” have often been used for dengue. Another report in The Telegraph that year quoted entomologist Dr Amiya Kumar Hati as saying, “I feel that many of the so-called Calcutta fever cases are actually classical dengue cases.”

“I have seen this for everything – leprosy, TB, malaria, dengue, encephalitis,” said Dr Shabana Roze Choudhury, an independent public health consultant and a medical doctor who does not practise. “I have seen this during the time of the CPM, and now, in the past four years, I have started working in UP and other states of north India and I see this there, too.”

The case of Zarir Udwadia

Dr Zarir Udwadia, one of the best known experts on tuberculosis (TB) worldwide and a practising doctor in Mumbai, writes in academic prose. He has 115 articles published in research journals. Early in 2012, Dr Udwadia received his quickest acceptance for an article. Within two weeks, in February that year, the journal Clinical Infectious Diseases published the article ‘Totally Drug Resistant Tuberculosis in India’ written by Udwadia and others.

It was based on four cases of TB that had been under Dr Udwadia’s treatment, which the doctor found to be completely resistant to the drugs available. He and his colleagues called the strain TDR – ‘totally drug resistant’ – TB. All first-line and second-line drugs had proved ineffective in treatment. The term TDR was coined in 2009 by A.A. Velayati and others based on their study of 15 patients in Iran who showed no response to the first and second line of drugs available to treat TB.

“Clinical Infectious Diseases is a prestigious journal, and it caused a stir in the medical world. The response from the Indian government was immediate,” Dr Udwadia told The Wire. “There was a ‘raid’ on our lab (in Hinduja Hospital) and seized the four cultures we had developed to study the strain of TB. They sent them to their own lab in Bangalore. There was pressure on me to retract the paper. There were questions raised about my work but I was most rattled by the way they took our cultures away. Hinduja hospital has one of the best research labs in the country, even if it is a private one.”

Subsequently, the World Health Organisation did not accept the term TDR, arguing that new drugs could be developed to counter this particularly difficult strain of the disease. They have settled instead on the term XDR: ‘extensively’ drug resistant.

“But they understood the severity of the situation,” Dr Udwadia said, “even if they differed on the language. Their tone was very different. With the Indian government, I feel, it is all about hiding the severity of the situation. I can’t trust any of our official figures.”