Patricia Mukhim
“The health of people is the foundation upon which all their happiness and all their powers as a state depend”
– Benjamin Disraeli, British Prime Minister.
Going by the above prescient quote from one of the great British Prime Ministers it should have been the remit of the Government of Meghalaya to ensure that its people do not ingest poison indirectly by consuming food and water that are toxic and breathing air that is heavily polluted. That would have been the responsibility of a government that cares for its people; not for the market forces. However, ensuring that people enjoy optimum health would also mean that the Government follows a set of policies that should have been crafted after due research about the present health status of the people of Meghalaya; the major health threats in the different districts of the state and coping mechanisms of people and also in understanding the new health challenges posed by climate change which essentially means dealing with new and more life-threatening diseases. Even today, Meghalaya has a huge population suffering from Basic TB, multi-drug resistant (MDR) TB, extensive drug resistant (XDR) TB and TB linked to HIV. It’s a different matter that mining data and statistics for all this is a difficult job unless a state-wide screening is done.
In the month of March this year the State Tuberculosis Officer, Meghalaya, DG Nongkynrih informed that in 2017, a total of 27,588 patients were screened out of whom 3,791 were diagnosed with Basic-TB, 252 of multi-drug-resistant TB, 13 cases related to XDR-TB, 53 cases of patients co-infected with TB-HIV and 206 cases of paediatric TB. The number of patients screened constituted only 0.91% (less than even 1% which is enough to arrive at any conclusion) of Meghalaya’s population. Out of this population 15% suffer some form of TB. A state-wide screening would give us a more graphic picture of the real situation. But TB is not the only disease we are grappling with. There is growing incidence of cancer too, much of which is linked to our food habits.
Statistics say that a total of 8338 cancer patients were registered in the Cancer Department of Shillong Civil Hospital between 2010 till 2017 and the patients included more males than females. Between January – March 2018, altogether 192 patients were diagnosed with Cancer. We have the numbers of only those patients who come to the Civil Hospital. Many more who can afford treatment outside the State are perhaps not registered. India’s North East has the highest number of Cancer cases and Meghalaya ranks fourth after Mizoram, Arunachal Pradesh and Manipur. In the April session of the Assembly, Congress MLA Zenith Sangma had cautioned about the chemically enhanced vegetables and foods that bring the risk of cancer. And George Lyngdoh, the MLA from Umroi had made a very pertinent point. He said food products should be inspected including local breweries.
And this brings me to the purpose of this article. For a while now we have been hearing the Health Minister, AL Hek blowing hot and cold over fish imported from Andhra. On Thursday the Health Minister informed us that 13 samples of fish sent for testing were found negative. Then he says that a formaldehyde detection kit was introduced for the purpose. Why should Meghalaya have to procure the kit when the testing is done in Guwahati? Why is the Pasteur Institute not upgraded into a multiple-testing laboratory since there is need to test soil, water, certain forest products and more. Why depend on Guwahati for issues of public health? That the State of Meghalaya till date does not even have a multiple facility laboratory for testing food products including fish and meat and has to send these to Guwahati is a shocker. In fact, even forensic tests are conducted at the labs in Guwahati. So this tells us how low on priority public health is in Meghalaya.
And now we are informed by a person with a vested interest in peddling fish and who is the President of the Khasi-Jaintia Fish Wholesaler and Retailer Association, Mitchell Wankhar that the fish coming from Andhra Pradesh has no trace of formalin. So we have to rely on a trader to certify the quality of the fish we are consuming. And sadly the public is just a disinterested onlooker. That precisely is the problem with public health in India – the public thinks the Government is doing it a favour by providing health care. Well, health is a human right and it is our duty to demand from the Government a better disease prevention regime, rather than just health care facilities. The International Agency for Research on Cancer (IARC) which is part of the World Health Organization (WHO) has concluded that formaldehyde is “carcinogenic to humans” based on higher risks of nasopharyngeal cancer and leukemia.
In Bhubaneshwar recently formalin was found in fish stocks available in the markets. According to Fisheries and Animal Resources Development Department Secretary, Govt of Odisha, Vishal Gagan traces of cancer-causing formalin were found in Pomfret fish samples, collected from the Unit-IV fish market in Bhubaneswar. A 12-member team from the department collected samples of around nine varieties of fish including marine, freshwater, and brackish water from the market. Since formalin content was found in Pomfret fish samples, Gagan said the entire stock will be destroyed if more fish tested positive. The Odisha Government took this step after the Assam government banned the import of fish from Andhra Pradesh. Odisha like most states mostly depends on Andhra Pradesh to meet its demand for fish.
This writer spoke to some scientists from NEHU to find out if there are adequate facilities for testing the presence of formalin in fish in their laboratories. They said they would need the formalin testing kit. They also informed that the State Government had sent two fishes in a plastic bag recently and wanted those to be tested but without any forwarding letter of any kind. If this is the kind of seriousness shown to a health threat then the public ought to be more proactive and demand that the fish be tested in their presence. Mr Wankhar and his ilk should not be the deciding factors in whether or not fish from Andhra Pradesh should be banned. The accurate findings from an accredited laboratory should determine whether we should still import Andhra fish into Meghalaya.
Contribution to the health of a population derives from social determinants like living conditions, nutrition, safe drinking water, sanitation, education, early child development and social security measures. What is appalling lacking in Meghalaya is community participation on governance issues related to public health. Public health should be a shared concern across the various sectors and although it is a politically challenging strategy such collective action is crucial.
Also a good system of regulation is fundamental to successful public health outcomes. It reduces exposure to disease through enforcement of sanitary codes, e.g., water quality monitoring, slaughterhouse hygiene and food safety. Wide gaps exist in the enforcement, monitoring and evaluation, resulting in a weak public health system. This is partly due to poor financing for public health, lack of leadership and commitment of public health functionaries and lack of community involvement. Government needs to implement public health laws by consulting stakeholders and by creating public awareness of existing laws and their enforcement procedures. The Health Department cannot work in a silo because many factors influencing the health outcomes of the public are outside their direct jurisdiction. Hence public health should become a shared value across the various sectors. This undoubtedly is politically challenging but not impossible. Above all, such collective action is crucial.
We the people of Meghalaya need to know we are not consuming poison through our food systems. And if other states have taken precautions why is Meghalaya on the back foot? Whose interests is the Government protecting?
We are aware that several fish merchants have invested heavily in fish ponds in Andhra Pradesh. So should that bear upon the Government more heavily than the health of its citizens? I am quite sure that with the scare of formalin laced fish having hit the headlines, the fish coming to Meghalaya might be temporarily devoid of formalin. But how does fish keep fresh in a 10-12 day journey over very hot climatic zones? Can anyone explain? Our lives are at stake!