Leave Delhi: That’s what doctors are prescribing to patients with serious respiratory ailments

11-time rise in ICU cases at Patel Chest Institute; pollution not only affects lung function, it hits blood pressure levels too.

Written by Pritha Chatterjee | New Delhi | Updated: April 2, 2015 10:36 am
Delhi air pollution, Delhi pollution, air pollution, pollution delhi, RSPM curve, respiratory ailments, respiratory diseases, air pollution disease, health problem pollution, pollution health problem, pollution lung disease, lung problem pollution, green delhi, delhi green, delhi pollution level, delhi environment pollution, environmental pollution, pollution city delhi, pollution delhi environment, delhi news, india news, nation news Prof S K Chhabra, head of cardiorespiratory physiology, VPCI, at his office on Tuesday. He says evidence clearly shows respiratory diseases are associated with worsening air pollution. (Source: IE photo by Neeraj Priyadarshi)

Jamil, Juhi Garg and Meera Prasad don’t know that the killer dust in Delhi’s air, RSPM (respirable suspended partculate matter), began falling after CNG was introduced and then, seven years ago, took a treacherous U-turn for the worse.

What they know is that their children cough and wheeze into each night — Jamil lost his first child to pneumonia — and after several trips to the hospital, there’s only one advice doctors have for them: Leave Delhi.

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Easier said than done, of course, but that advice betrays the sense of despair in the city’s health establishment over public policy failing to respond to a public health disaster in the making.

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Records investigated by The Indian Express from the Out Patient Departments (OPD) of Delhi’s leading hospitals show that after the Supreme Court order of 1998 led to public transport vehicles switching to the cleaner CNG fuel, the two main hospitals handling a bulk of respiratory ailments reported a clear dip in cases.

death-by-breath

Like the RSPM curve, which this investigation mapped yesterday, the number of OPD cases at the Vallabhbhai Patel Chest Institute (VPCI) and All India Institute of Medical Sciences (AIIMS) hit a low a few years after that verdict.

ALSO READ: Even the Chief Minister is a victim

Then, they started to spike, as RSPM levels rose from 161 µg/m3 (microgram per cubic metre) in 2007 to 316 µg/m3 in 2014.

Consider these:

VPCI: The number of OPD cases dipped from 51,694 in 2003-04 to 47,887 in 2006-07 and then started rising to reach an all-time high of 65,122 cases in 2013-14.

AIIMS: The trend is similar, from 10,296 OPD cases for respiratory ailments in 2005-06 to a low of 9,519 in 2007-08 and again, an all-time high of 37,669 in 2014-15.

To place that last figure in context, AIIMS started a separate respiratory department in 2013.

Admitting that these numbers are cause for serious alarm, Dr Randeep Guleria, head of respiratory medicine, AIIMS, told The Indian Express: “What is most worrying is that 10-15 years ago, when air pollution levels had come down, our average OPD attendance and admissions in respiratory medicine at AIIMS saw about a 20% decline. We seem to have lost out on our own achievements. As pollution levels have gone up, our public health success has been reversed.”

death by breath data

Dr Rahul Nagpal, paediatric chest specialist at Fortis VK, said, “I have lost count of the medical certificates I have written for schoolchildren this winter. As a doctor, I am often forced to advise holidays to patients because a change of environment with better air quality helps them improve faster.”

What’s needed, says Dr Guleria, is action at the policy level.

“The poor air quality has persisted for too long, and there is enough evidence of its link to health effects. It is time that we see some policy action to not only control this but also ensure that we hold on to any success we achieve this time,” he said.

Additional data accessed by The Indian Express from AIIMS and VPCI also confirm that the the air we breathe is most dangerous around when the winter begins to set in from October to December. That’s when the cold air creates low pressure conditions that prevent pollutants in the air from dispersing, leading to episodes of smog and fog.

But now, data shows, patient numbers during this period have been sharply rising over the last three years (see box).

Dr Rajendra Prasad, director, VPCI, said that this is the time “when we see more of patients with chronic or long-term respiratory diseases like Asthma and Bronchitis having complications”.

Data from the institute shows that the number of patients admitted in its respiratory wards increased by 79% — from 2,160 cases in 2003-04 to 3,873 in 2013-14.

“The admissions and emergency cases are reflective of such exacerbation in symptoms. So in our experience as a tertiary care hospital, which sees more referrals of complicated cases, air pollution not only causes respiratory symptoms but also exacerbates underlying respiratory diseases,” Dr Prasad said.

According to Prof S K Chhabra, head of cardiorespiratory physiology, VPCI, “Evidence clearly shows that both acute respiratory and chronic respiratory problems as well as all-cause and respiratory mortality are associated with worsening air pollution. Evidence has accumulated to show that particulate air pollution is also linked to cardiovascular morbidity (angina, myocardial infraction, heart failure) and mortality.”

The doctors said that in very serious cases, they almost always remind the patient of the option to move out of Delhi.
“That’s what doctors at Lady Harding Medical College advised me to do if I wanted to save my children,” said Jamil, a driver from East Delhi.

Jamil added that he lost his newborn son to pneumonia five years ago in December. “Last November, about a week after Diwali, my four-year-old daughter started coughing and wheezing. It was the same cough. My wife and I can never forget the sound or sight of our girl struggling to breathe. Within days, our third child, a newborn daughter got the same cough,” he said.

Both the girls recovered but Jamil said he will never forget those days or the advice that the doctors gave him. “They said I should send my daughters to my village, near Gorakhpur, every year after November because it gets difficult in Delhi at that time,” he said.

Meera, a resident of Gurgaon, said that her eight-year-old son has “never had a free childhood”.

“He has given up on activities like swimming and skating which he loved. He avoids dust. Even if he climbs a fleet of stairs, he feels tired. Every year, his condition worsens after Holi in April, and after Diwali around November. Doctors told me that both correspond to an increase in pollution levels,” she said.

Juhi, a chartered accountant from South Delhi, said that doctors have clearly linked the “respiratory problems” of her 11-year-old daughter to air pollution.

“My daughter is an asthmatic. From the age of 5-6 years she has been on medicines like anti-allergens, and even now I always carry a nebuliser. She was hospitalised 3-4 times earlier from asthmatic attacks, when she missed school. Doctors have told me pollution is a factor in her respiratory problems,” she said.

Dr Arup Basu, director of chest medicine, Sir Ganga Ram Hospital, said that it’s not just respiratory diseases that are triggered by Delhi’s dirty air.

“There is a direct co-relation not only between pollutant levels and respiratory diseases, but also with cerebrovascular problems, blood pressure levels and even cardiac events,” Dr Basu said.

“When our respiratory attendance spiked this November-December, we convened a meeting of all consultants and analaysed the data. We realised that while earlier only upper respiratory complications such as cough phlegm, and breathing difficulties were common, now more patients complain of serious lower respiratory problems indicating that pollution has entered the lungs.”

Dr Basu also urged the government to take “scientific measures” to resolve the crisis.

“We do not need another winter like the one we saw with so many patients, especially children and the elderly, falling so sick and taking longer to recover. We need the government to take scientific measures to prepare an action plan to prevent what has become like an annual cycle,” he added.

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  1. A
    arishsahani Arish
    Sep 1, 2015 at 7:20 pm
    All we need is first to take care of our created garbage handled properly. Garbage littered all around polite air. This will solve your 50% of air problem .OuR Chief Minister Kejriwal wants PM out and get his post but will do nothing on ground for people who elected him.
    Reply
    1. B
      B.Krishnamurthy
      Apr 1, 2015 at 8:23 pm
      I have shared this article in my Face Book timeline. I wanted to forward this article to my daughters residing in New Delhi. I regret that I failed in my attempt.E Mail facility which is appearing in the top page of the article is 'non functional. B.Krishnamurthy
      Reply
      1. B
        Bloggervat Bloggervat
        Apr 1, 2015 at 8:59 am
        Thats why its better to be in a city like Chennai, Pune, Bangalore or chandigarh. Cities which can expand radially are the best bets to live in india. These cities have a good planning structure compared to Delhi
        Reply
        1. S
          Sudhakar
          Apr 1, 2015 at 11:18 pm
          Shops, offices, schools and colleges should be at walking distances from residential area. Only then the air pollution due to traffic can be reduced.
          Reply
          1. D
            Dashrath Babu
            Apr 1, 2015 at 7:35 pm
            In Delhi if " SHASTRI BHAVAN" WHICH IS EQUAL TO PENTAGON IN USA can be accessable by Key Makers, Peons & Drivers in collution with CISF ,in night time NOTHING TO EXPECT FROM more than 1000 IAS officers who are camping in Delhi since 20 years with Political Patronage & enjoying all the Govt facilities, Foreign Jaunts every month in the Name of SEMINARS, who is bothered about POLLUTION CONTROL, it is a shame that woman & cityzens are not Safe after 8 PM in Delhi, MODI to note.
            Reply
            1. D
              Dipak
              Apr 1, 2015 at 9:20 am
              Good, send this guy KEJARI to stan.
              Reply
              1. E
                eusebiopecurto
                Aug 19, 2015 at 2:41 pm
                The climatic Change is a global problem with serious social and economic implications of environmental Happy Sustainability 2015
                Reply
                1. G
                  Gautam
                  Apr 1, 2015 at 11:23 am
                  Delhi has chosen a party who promises to make the city more polluted (he plans to have coal plants in the city!) and more bankrupt by providing "free" water and electricity (another political gimmick - no free lunches in life!). Coal powered plants will do nothing to address peaking power shortages which force people to burn heavily polluting (and much more expensive) diesel and kerosene generators. Do people in the city not see the true cost of their choices? A dying city, a childhood lost in sickness for its youth, lower investment and dwindling jobs (why would anyone want to move to the most polluted city in the world !).
                  Reply
                  1. G
                    Gopal
                    Apr 1, 2015 at 11:03 am
                    The problems of Delhi are mive urbanization that has led to environmental degradation. But more people keep pouring in and free water, electricity and slum regularization will make it worse. This problem needs a multi faceted solution. This includes reduction in factories, transportation, and even cooking. Also needed are power generation that is based on solar instead of coal based plants. Sadly none of this is possible as long as we keep electing populist politicians. AAP is the new avatar of populism and it will certainly lead to further environmental degradation.
                    Reply
                    1. J
                      Jayan
                      Apr 1, 2015 at 6:11 am
                      Air pollution is a serious health hazard in most Indian cities. With the real estate boom, infrastructure creation and unhindered industrial expansion it has become citizens to breathe fresh air. It becomes very acute for the very young and the elderly. I think we should look at economic growth in a balanced way without effecting the health and well being of our citizens. Looking at green technologies,using solar and wind power and building homes that suit our environment are some of the steps in the right direction.
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                      1. M
                        m davar
                        Apr 1, 2015 at 6:57 pm
                        undoubtedly pollution increases in delhi during winter and also after diwali. increase in disease like breathing and heart problem is not only health problem but also bad for tourism. it is big economic loss to india which requires faster growth. traffic from adjoining states ping through delhi should be diverted by speedy implementation of diversionar expressways. supreme court has already expressed disapppointment in inordinate delay. also govt should propagate less use of personal cars and more use of public transport which shd be improved. also there shd be more publicity on adverse effects of air pollution. cleanliness in garbage collection and use of alternative methods to piling up of wet garbage from nalahs should be examined.
                        Reply
                        1. A
                          ajay
                          Apr 1, 2015 at 8:54 am
                          Third rate article only takes the names of doctors why it has gone up when it was declining before respiratory illness goes up all over the world in winter months .We need better information rather than publicity.
                          Reply
                          1. N
                            Nb Nair
                            Apr 2, 2015 at 9:01 am
                            All these percentage increases in air pollution will be totally upset in the near future. There are reports that the incinerator lobbies are out there to influence those in power and position in NCR to get nothing less than 14 incinerator units installed. These incinerators wrongly thought to be solving MSW problems had proved to be the most air polluting MONSTERS the world over - WHO Reports - within a decade of their installations. Just imagine what you are waiting for?
                            Reply
                            1. J
                              John Nikos
                              Apr 1, 2015 at 1:54 pm
                              Traffic on the roads in Delhi will have to be drastically cut, as the shocking revelations in this news story shows. Public transport needs to be promoted and expanded while the use of private vehicles, the numbers of which keep rising exponentially, needs to be curtailed. This has become more urgent that ever before.
                              Reply
                              1. P
                                pra
                                Apr 1, 2015 at 2:45 pm
                                better than leaving delhi educate people to avoid pollution or else if all delhities migrate to other state then the same situation will follow to other states too....better do some medical workshops in all states or through television make public understand the effect of pollution n the seriousness of it...better to stop giving this kind of suggestions bcoz itz not going to workout bcoz ppl cant leave their work n schools colleges etc n shift sumwhere else.....be logical
                                Reply
                                1. R
                                  rs
                                  Apr 1, 2015 at 1:27 pm
                                  Kejriwal is a victim of this. Let us watch what action he will take.
                                  Reply
                                  1. A
                                    Adi
                                    Apr 1, 2015 at 8:56 pm
                                    Doctor told me not to walk outside in the mornings in Delhi. I left the city (& country) for good. I feel so much happier.
                                    Reply
                                    1. C
                                      ContraRiAn_and__
                                      Apr 1, 2015 at 11:01 am
                                      The more Delhi-ites leave Delhi and move elsewhere, the more the AAP wildfire will become a nationwide (international?) phenomena
                                      Reply
                                      1. R
                                        ram
                                        Apr 1, 2015 at 11:30 am
                                        There should be complete ban on these heavy firecrackers during Diwali and as well during the marriage season.unless until govt comes heavily on these nothing will improve in delhi. Two things will improve noise pollution and airpollution .
                                        Reply
                                        1. S
                                          S.K.Gupta
                                          Apr 1, 2015 at 11:06 am
                                          How does Arvind Kejriwal, Delhi's CM intend to deal with its ecological problem of having an extremely high levels of pollution of which he himself is a proven victim? "Leaving Delhi" could be an "Out of Box" idea of some of the highly reputed medical experts dealing with this menace in the capital. But is that truly a permanent and acceptable solution for the basic environmental problem? Why not address this growing menace by immediately adopting various preventive measures as also initiating the long lasting solutions by urgently bringing down the alarmingly high pollutant's level here. The govt will have to take some bold steps like banning new vehicles in the capital and imposing exemplary fines upon those (including govt vehicles) who may be actually responsible for vitiating the ecological environment in the capital. Even a "round the clock" check should also be kept on the polluting industrial units here. The Safety alone saves.
                                          Reply
                                          1. S
                                            S.K.Gupta
                                            Apr 1, 2015 at 11:20 am
                                            It's not a cake walk. The govt of Delhi must rise to the occasion leaving aside its political compulsions and take suitable remedial steps to contain this menace. The basic causes of extant large number of "pollutants" is very well known. But the need of the hour is to hit the nail on the head. Can Arvind Kejriwal's govt muster enough courage to effectively deal with this problem in its right earnest more so when he is armed with AK 67?
                                            Reply
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