The media’s role in Kerala’s healthcare setbacks

As Kerala, whose gains in health care had been compared to the first world standards, is facing a huge challenge owing to the spread of epidemic threats on a regular basis and the slippage in areas like vaccination for immunization, the role of media in the downward trend is coming in for criticism. A number of concerned scholars and activists have made the accusation that irresponsible and often ill-informed media coverage of health affairs even in the mass circulated newspapers has had a negative impact on health care activities in public sector.

 

They question the media’s negative coverage of health issues and its role in spreading half-truths and plain falsehood as news in recent years. They also question the media’s preparedness and objectivity in covering matters of scientific and technical nature with little training or expertise to handle such affairs. Many health activists and eminent doctors in the public sector health service seem to share the view that media coverage of health affairs in Kerala is generally ill-informed and biased. There is concern that it could seriously undermine the gains the State had made in health care in the past decades, thanks to a public sector health care system.

 

 A number of factors including the decline in budget allocations for health and education since 1991 have contributed to the present situation, where some of the major epidemics which have been eradicated from the State decades ago, such as malaria, cholera and polio, are making a comeback. Other seasonal outbreaks such as cases of Chikungunya, Weil’s disease, etc, are proving to be regular incidents every year. In fact, the President, Prathibha Patil, on her first visit to the State recently, made a pointed reference to the serious nature of the threat to Kerala’s health care and cautioned against slippage in its gains which had received great encomium from the world over, including from scholars like Dr. Amartya Sen.

 

Even as the government is accused of withdrawing progressively from its health care commitments, it is being pointed out that media has been overtly critical of the public health care facilities indirectly promoting a thriving private sector. The major criticism against media is that reportage on the failures/slippages of the public sector is often highly exaggerated and without any cross checking, giving a false and often misleading picture to the common people. While deaths in government hospitals get headlines, the same in private hospitals generally go unreported. The case of reporting on Chikungunya, a disease that is caused by mosquitoes, as it spread across the State during the recent monsoon is an example.

 

 Newspapers reported about deaths in scores and then in hundreds resulting in a mass exodus from coastal areas like Cherthala in Alapuzha which had been hit seriously by the disease. The public sector health centres (PHCs) and hospitals and the State Department of Health were particularly targeted for criticism. But the mortality figures were proved wrong later, as proper studies were taken up by the Central and State health authorities. However, the alarming fatalities reported in media during Chikungunya season could be attributed to confusion among official sources themselves, as there were differing views on it between the State and Central authorities and even between the Chief Minister’s office and the Health Minister’s office in the State Government.

 

 But that the media coverage often is biased and ill-founded, is beyond doubt. In a recent article, titled Scoop Journalism- A New Threat to Public Health, published in the Journal of the Government Medical College, Kozhikode, and also in Sastragathi, a monthly magazine of the Kerala Sastra Sahitya Parishad, Dr. K P Aravindan made a scathing criticism on the media for their "irresponsible ill-informed" reporting on health affairs. He cites the reporting on the neo-natal deaths in the public sector SAT Hospital in Thiruvananthapuram, in a mainstream newspaper with over a million copies in circulation, as a case in point.(The news item was reported by Mathrubhumi, the second largest daily in Malayalam, though Dr. Aravindan does not give the name of the newspaper in his article.) The initial newspaper report, which was later picked up by other newspapers and various news channels, said that there was a huge increase in the deaths in the neo-natal ward of the Government’s premier mother and childcare hospital with a suspected outbreak of infections.

 

In his well argued study of the newspaper coverage of the incident, Dr. Aravindan points out:  As the visual media and newspapers took up the issue, nobody bothered to check the real figures [of mortality] and compare them with the previous years. It was also not made out in the reports that the problem, if any, was confined to the newborn nursery, where most of the babies admitted were premature and of low birth weight, resulting in a higher mortality rate.

 

He makes a comparison of the statistics with the previous year’s mortality rates and finds that there has not been any substantial increase in the death rate at all. "Overall, no dramatic difference is perceivable. The data certainly shows no evidence of a major outbreak of nosocomial (hospital acquired) infections in SAT Hospital this year," he concludes.

 

Similar conclusions have been reached by other studies on developments in health sector in the State. Recently, the Achutha Menon Centre for Health Science Studies (AMCHS), attached to the Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, had found that there has been a setback to vaccination campaigns for immunization in some areas, mainly in north Kerala, which scholars attribute largely to negative media coverage of such vaccinations. The study, entitled Current Status of Service Delivery in the Health and Family Welfare Sector in Kerala, released in January  2005, looked at 5000 households from five districts, representing various geographical  regions in the State.

 

The report says: Immunization coverage of children between 12 and 23 months was found to be low in Malappuram district. In all other districts, coverage of DPT 3 and OPV 3 was over 90 per cent. However, in Malappuram district both DPT 3 and OPV 3 coverage was less than 50 per cent. This is surprising since the TT coverage for pregnant women in Malappuram was 90 per cent. After a period of ‘No polio’ case in the State for more than three years, one case of polio was reported in Malappuram district. Therefore there is an urgent need to improve immunization coverage in Malappuram and areas of low coverage in other districts.

 

The survey report does not make any direct reference to the reasons behind this "surprising phenomenon in Malappuram", though it points out that lack of access to health care facilities is not the issue here.   Dr. K R Thankappan, who led the AMCHS survey, said that there has been a major decline in children’s vaccination in Kerala in recent years compared to the progress registered by Tamil Nadu. Quoting from the National Family Health Survey (NFHS-3) statistics, he said that proportion of children between one and two years who received all the mandatory vaccination was 81 per cent in Tamil Nadu, while it had dropped to a mere  75 per cent in Kerala. According to him, the incessant anti-vaccination campaign carried out by a section of Malayalam media, including highly respected newspapers, is responsible for the situation. As a consequence to the decline in vaccinations, he also refers to another major health indicator, the infant mortality rate (IMR), going up in Kerala, while it is showing a fast decline in Tamil Nadu. (The IMR which had dropped to as low as 10 per 1000 in Kerala in the mid-nineties, stand at 15 /1000 according to recent NFHS data.) Though the NFHS figures may not be statistically very accurate, the trend is unmistakable and they must be seen in the context of a highly negative media atmosphere in Kerala, he felt.

 

Dr. B Ekbal, an internationally known heath activist and former vice chancellor of Kerala University, in an interview to this writer, said that though the setbacks to the health care gains in Kerala could not be fully attributed to media coverage, there is a real and dangerous nexus between the media and certain groups which campaign against modern medicine and vaccinations. "It is a fact that media in Kerala is generally unscientific and goes by hearsay," he said. He said that the campaign unleashed by small groups including the anti- vaccination lobbies like the homeo and naturopaths’ groups, some "cultural leaders" and religious fundamentalist groups who get disproportionate coverage  in the media, did have an impact on the low vaccination levels in some parts of the State, especially among the poorer sections. He pointed out that the AMCHS study had proved that drop in vaccinations were mainly confined to some backward areas in districts like Malappuram, which show that these campaigns did have an impact on the socially and educationally backward sections like Muslims in the State. It appears that media influence among these backward sections is comparatively higher than among the middle classes who have other sources of information.

 

To prove this point, Dr. Aravindan refers to a recent media attack on vaccination for immunization launched by some of these groups and the local media in Kozhikode district following the death of a school girl in Kallachi, a Muslim dominated area, a few days after she received a TT vaccination from the school.  He says: After the death of the girl in Kozhikode district many weeks after tetanus toxoid vaccination, it was alleged that the death was due to vaccination.  The allegation had been proved wrong. The offshoot of the media handling of the event was that immunization rates dropped in the area. He said that the district officials had to carry out a special campaign there to encourage children to accept vaccinations, as the drop was alarming in the immediate wake of media reports about the death of the girl.

 

What is surprising about these events is that while most of the highly charged reports are proved to be half-baked or baseless later on, there is no soul searching or retraction by the media. In fact, in spite of the serious criticism raised by intellectuals and health activists about the media coverage, there has not been any effort on the part of the media to take note of the situation. The Kerala Union of Working Journalists (KUWJ) at its State conference in Thiruvananthapuram recently, made an attempt for a dialogue with the experts and activists on various aspects of media coverage on sensitive issues and their fallout, but it was attended by only a few persons from the media. That calls for some other ways to find a solution to educate the media on simple matters of scientific nature. As one agonized doctor said, the media itself need to analyze these events and try to evolve a code of conduct regarding reporting of public health issues.