For more than seven hours, Farooq Hussain, 13, has been lying in a crowded corridor of India's most prestigious hospital in New Delhi, the All India Institute of Medical Sciences (AIMS), waiting for a doctor to treat him for dengue fever. Farooq was brought to the capital by his parents, landless labourers from a remote village in Bihar, in eastern India. It took them one-and-a-half days by train to reach AIMS, the one government hospital that every poor Indian has heard about. When Farooq's fever refused to go down and his gums began bleeding - a sign of the dreaded stage known as dengue haemorrhagic fever - his father, Altaf Hussain, took him to the primary health centre in the nearest town. It was deserted and locked. Nearby residents told him the staff rarely came to the clinic. By now sick with worry about his only child, Mr Hussain took the boy to a government hospital in Patna, the nearest city. 'At Patna, they said they couldn't treat him because his condition was serious. They told me to bring him to AIMS but he's become much worse during the long train ride,' Mr Hussain said as his wife placed another cold compress on her son's forehead within the packed confines of the hospital. In the overflowing corridors, wards, car park and entrance of AIMS, there is pandemonium. Doctors struggle to treat the hundreds of suspected dengue cases flooding the hospital from all over the country, in a disease outbreak that has exposed the shabbiness of India's public health system. 'If AIMS is failing with dengue when the figures are not even that high, I dread to think what kind of catastrophe we would have if something worse happened,' said paedatrician Kumari Aggarwal, as AIMS ran out of beds, blood and platelets. On some days in the dengue wards, relatives were administering saline drips to patients because of the doctor and nurse shortage. Distressed patients, often young children, lay on gurneys in the car park waiting to be treated. Last week, the hospital had to put up temporary tents on the institute campus to cope with the stream of patients. By last weekend, 44 people had died of dengue at AIMS alone and an estimated 140 throughout India. Dengue, a mosquito-borne disease, is usually not lethal if treated early, before it reaches the dangerous haemorrhagic stage when patients start bleeding from the nose, gums and skin. Most of the dead would undoubtedly have survived if they had received timely diagnosis and treatment near their homes instead of travelling hundreds of kilometres to the capital. The biggest irony of all is that AIMS was the epicentre of the epidemic. The hospital failed to observe basic prevention rules, such as removing pools of stagnant water - the perfect breeding conditions for the Aedes mosquito, the carrier of the virus. Municipal Corporation of Delhi officials said they had served 27 notices to the hospital for violating the rules regarding mosquito breeding on its campus. The hospital ignored them and became a hub for the disease. Among the first to contract dengue were a dozen AIMS doctors and resident medical students. One student died. 'We're in trouble when a medical student in India's premier hospital dies of dengue. He wasn't in some remote village. What hope is there for the millions in the countryside?' asked maths teacher Seema Goswami whose husband was admitted to hospital for dengue. Belatedly, as the death toll mounted, the Health Ministry issued advertisements warning people to make sure their homes were free of stagnant water. Armies of municipal workers began fumigating high-risk areas. 'This was worse than shutting the stable door after the horse has bolted. The public awareness campaign and the spraying should have been done months before,' said Judge Vijender Jain of the Delhi High Court, responding to a public petition accusing the Delhi municipal government of failing to take preventive steps. The failure was all-encompassing. Middle-class Indians should have known that once the summer heat had abated and they had stopped using air coolers - a popular alternative to expensive air conditioners - the water had to be dried out. It was only when the headlines began screaming about dengue deaths - and Prime Minister Manmohan Singh's grandsons were admitted to hospital with the disease - that middle-class families began checking for water collection. The government was equally remiss. Public health officials had expected an outbreak this year because of the disease's three- or four-year cycle. 'Open drains were not covered. No systematic fumigation took place. There is really no point launching public awareness campaigns when people have started dying. Preventive measures should be carried out automatically every year but there is no will to do this,' said Sanjiv Malik, national president of the Indian Medical Association. Claims of government inaction and public ignorance have been mounting in recent years. In 1996 a dengue outbreak in Delhi claimed more than 400 lives when 10,000 people contracted the virus. The latest outbreak reflects the crisis gripping India's public health system as it struggles to cater for its more than 1 billion population. In the cities, it's overburdened. In the villages, it's virtually non-existent. It's short of funds and manpower. Hospitals are short of beds, basic medical equipment, manpower and medicines. For every 10,000 Indians, there are six doctors, compared with an estimated 15 in China, according to the World Health Organisation. In some backward states such as Bihar, government hospitals look like sheds, with no bandages or cotton wool. The X-ray machine is usually a useless piece of rusting metal because the money meant for maintaining it has gone into someone's pocket. Primary health centres are meant to cater to the needs of the rural poor. As such, they're the cornerstone of the rural health-care system. Most have no vehicles, running water or electricity; only 20 per cent have phones; and only 70 per cent have a bed, according to World Bank figures from 2004. A village woman can walk into one of these centres to get something for her baby's cough and not find any cough syrup. Nor will there be medicines for common ailments such as fever, vomiting or diarrhoea. An Oxfam report published last week said that 'every half an hour, six nameless Indian women die in childbirth because only 40 per cent of rural clinics have labour rooms'. The staff are often absent. A World Bank survey of rural clinics in Rajasthan two years ago revealed that medical personnel were absent 35 to 40 per cent of the time. The absentee doctors and nurses are usually earning money somewhere else while drawing their government salaries. Since the centres have no phone, it's impossible to check if they're present. For the countless thousands of poor Indians who flock daily to Delhi and other cities for hospital treatment, they find that many city government hospitals look like something out of the Middle Ages. Dingy and primitive, the hospitals might have placed patients two to a bed while flea-infested dogs stretch out in the corridors. It's the rural poor who suffer the most from the inadequacy of health care because every time they leave their work to travel to a city, they lose out on whatever little daily income they earn. The corridors of Safdarjung Hospital in the capital are identical to the scenes at Indian railway platforms. Families who cannot afford lodgings sleep and eat on the floor. There is nowhere to bathe or rest. They cook their meals on kerosene stoves in the car park. India's public health spending is among the lowest in the world - about US$4 a person per year, less than 1 per cent of GDP. In China, it's 2 per cent of GDP. In the US, it's US$2,000 per person, almost 6 per cent of GDP. While medical treatment in state hospitals is free, tests and medicines are not. 'Health is one of the biggest reasons for personal debt in India, including the rural indebtedness that drives people to suicide,' health writer Pamela Philipose said. HIV/Aids is also a cause for concern, with 5.6 million HIV-positive people in the population. 'If we don't stop it in its tracks, public hospitals will be inundated. You'll have Aids patients dying on the streets,' said Ashok Alexander, director of the Bill and Melinda Gates Foundation in India, which funds Aids groups. Affluent Indians often jeer pityingly at poor Indians who go to quacks when they're sick. But, faced with an unreliable public service, they have no choice but to resort to those with dubious medical qualifications. Or they go to traditional healers, with the results of this 'treatment' - wrong diagnosis, wrong medication, wrong dosage - only making it to the newspapers when they're particularly grotesque, or fatal. Shiva Reddy, a driver in north Delhi who took his five-year-old son to an 'orthopaedic surgeon' in August for a broken arm discovered only later, when the boy's arm was paralysed, that the man was not even a qualified doctor. 'Because he was private, I thought he'd be better than a doctor at the government hospital near our home,' said Mr Reddy, demonstrating the painful choices faced by the poor.
