Thiruvananthapuram: The coastal belt of Thiruvananthapuram continues to be vulnerable to frequent outbreaks of infectious diseases, both vector-borne and water-borne, in the absence of any sustainable disease prevention programmes for the fishing community.

Even as unhygienic living environs and low accessibility of the fisher folk to quality health services continue to precipitate new challenges, the entire network of the State's primary health care facilities along the coast remains ill-equipped to offer comprehensive health care to the coastal population.

Standardising system

Standardising primary health care institutions and developing select institutions in strategic locations along the coastline to offer comprehensive diagnostic and clinical facilities would be more beneficial than having a string of under-utilised institutions, officials pointed out.

Poor nutrition and high levels of anaemia among the coastal population, congested living conditions and water-logging are the main reasons for the frequent outbreaks of malaria and dengue fever. Outbreaks of water-borne diseases like diarrhoea and cholera are also not uncommon; a cholera outbreak along the Pulluvila and Poovar area three years ago left many affected.

A United Nations Development Programme study in 1997 done in select coastal areas in Thiruvananthapuram reported high levels of gynaecological morbidity among the women here. Of the 1,400 women surveyed, about 30 per cent had problems like reproductory tract infections or pelvic inflammatory diseases. However, the majority had not sought medical care because of poor awareness and limited accessibility to gynaecological services.

Gynaecologists' service

The study recommended that the service of gynaecologists be made available in the area and that a mobile medical team with a cytologist be set up for the coastal belt to offer basic care to fisherwomen.

Though there are about 15 primary health centres (PHCs) along the Thiruvananthapuram coast, gynaecological services are not provided in any of these institutions. Women here have to depend on private clinics.

Lack of modern diagnostic facilities is another major problem affecting systematic disease control measures in the area.

"A major lacuna in coastal health management is the lack of a sustainable disease surveillance system. The department is good at crisis management but when it comes to programmes for long-term prevention, we draw a nought. Improving sanitation facilities and provision of clean drinking water alone can help prevent a host of seasonal outbreaks on the coast," a senior health department official said.

Of the 12 PHCs — Poovar, Pozhiyoor, Pulluvila, Kottukal, Mukkola, Poonthura, Veli, Puthukurichi, Perumathura, Andoorkonam, Edava and Puthenthopu — five offer in-patient facility. In-patient facility is also offered by the community health centre (CHC) at Vizhinjam and Anchuthengu and the government dispensary at Valiathura.

No manpower

However, not a single institution has the manpower or the facilities to offer round-the-clock care. Doctors do on-call service here and for all night-time emergencies, the nearest place for people is the Medical College hospital.

As per service rules, a minimum of eight doctors are required for an institution to offer 24-hour care. The Vizhinjam CHC has the post of five doctors; the Poovar and Poonthura PHCs have four doctors each. Three of these institutions have in-patient facilities and at least one could be developed and additional posts of doctors created to offer 24-hours care, it is pointed out.

There is also a gross disparity in the distribution of services offered in each institution. Some of these are under-developed and over-utilised while many others have scantily used facilities. The CHC in the coastal area of Anchuthengu has no-in-patient service, while the Government dispensary at Valiathura has a 34-bed in-patient unit.

Lack of good residential facilities for doctors is one of the reasons for the reluctance of doctors to serve in coastal areas. The doctors' quarters at Vizhinjam has been under repair for a while now; the quarters at Poovar does not have water supply; at Valiathura and Poonthura, there are no residential facilities for doctors at all.

Re-deploying staff from idling PHCs like Veli and Kuttichal to busy PHCs, posting doctors from other districts are temporary measures that can be adopted to maximise the utility of institutions.

Given the poor social, economic and environmental conditions in the coastal belt, a separate coastal health surveillance and management system is required to improve the health of coastal population, Health department officials point out.

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