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I
shall call her Madhu, but her name is not really important.
For her experience is one that is only too common, except
perhaps that it has had a better outcome than many others.
Madhu
works as a maid in a home in South Delhi, an economic
migrant drawn to the city to earn some money for herself
and her family back in the village. She was lucky: she
found a place to stay with reasonable employers. When
she fell ill, her employers paid for her to consult
a series of private doctors recommended by friends and
neighbours.
It was just as well that they did, because the doctors
she consulted all charged quite high rates even though
their clientele was typically quite poor, and insisted
on a range of expensive tests - scans, X-rays and the
like - before coming to any diagnosis. So in a matter
of three weeks, the private medical treatment had cost
Madhu several thousands of rupees.
Yet this succession of doctors was somehow unable, notwithstanding
these tests and the many pills and injections which
they inflicted upon poor Madhu, to deal with the actual
illness, which in fact was a severe urinary infection.
So Madhu was already in a weakened state when she experienced
very high fever.
This fever too was dealt with by a local private doctor
in the simplest possible way - through an injection
which lowered the fever without addressing the cause.
Yet the latest fever, and symptoms that accompanied
it, turned out to be caused by dengue, the mosquito-borne
viral disease that has assumed epidemic proportions
in Delhi.
By the time this was finally diagnosed correctly, Madhu's
condition was extremely serious because her blood platelet
count had fallen to critical levels and she was in urgent
need of hospitalisation. But even this is not straightforward
in Delhi. The richest city in India in terms of per
capita income has only a handful of hospitals that are
equipped to do the necessary blood platelet transfusions,
and these hospitals were already either filled to overflowing
or ruinously expensive.
The two government-run hospitals with the required facilities
both already had more patients than beds, and one of
them was reeling under its own local dengue epidemic.
So at first it seemed that she could not even be admitted
to a hospital despite being in this critical condition.
Once again, though, Madhu was ''lucky'': her employers
knew someone important who knew someone more important,
which is how most things are managed in this city.
After some string-pulling, Madhu was finally admitted
to the Emergency ward of one of these government hospitals.
She had to share a bed with two others in a ward bursting
at the seams with three times the people it could formally
hold, all in varying degrees of distress or criticality.
The ward was in utter chaos, with the already basic
facilities being completely overstretched, new patients
arriving every few minutes and periodic crises to be
handled only by a small group of utterly overworked
doctors and nurses. Naturally, there was little possibility
of ''normal'' hospital procedures in such circumstances,
or of individual care for any one patient.
In spite of the dreadful conditions, Madhu was treated,
and is now recovering, so her story is about survival.
But there were (and continue to be) many others who
were less lucky: those who came in too late, those who
could not even get into the hospital, those who never
got diagnosed properly despite going to doctors, those
who could not even afford to go to the doctors in the
first place.
For all those who are currently obsessed with the emergence
of India as the new kid on the block of potential economic
superpowers, exposure to the conditions in most of our
government hospitals should be made compulsory, as an
important antidote. It is immediately apparent in any
of these places that the problem is not one of ''poor
management'' as is often assumed about publicly run institutions.
On the contrary, it is really a miracle how the doctors,
nurses and other staff of these hospitals manage to
deal with the torrent of cases that they are exposed
to on a daily basis. The real problem in all of these
places is one of complete shortage - of medical professionals,
of other staff, of rooms, of beds, of equipment, of
medicine, of everything. Government health facilities
that were set up to cater to a few lakh citizens are
now having to deal with a reference population of several
million, and they are deprived of crucial facilities
and adequate numbers of health workers.
So it is not surprising that the care is inadequate
or the conditions are poor; what is surprising is how,
despite, these truly appalling circumstances, the basic
health care and even the more complicated care, are
still delivered regularly in government hospitals. But
obviously, for any improvement in these unacceptable
conditions, there must be a much larger infusion of
public funds to provide all the things that are now
in such short supply, from physical infrastructure to
human resources.
The abysmal conditions of health care in our country
- both public and private - are often ignored by the
elite, which has seceded into its own privileged world
of five star hospitals financed through expensive medical
insurance. And even among those with a stronger sense
of reality, it is often assumed that the real health
gap is the rural-urban one, especially since even public
expenditure on health disproportionately favours urban
areas.
Yet the poor - and the not-so-poor - in urban India
are also very badly served by this system, which lets
them down on so many counts even while forcing them
to pay larger shares of their own income on health care.
There are public failures in terms of inadequate investment
and inefficient regulation. The parlous state and sheer
difficulty of access of government hospitals forces
even the poor to turn to private practitioners.
But in private care especially for the poor, there is
a proliferation of poorly trained or even completely
spurious practitioners, who somehow have to recoup the
large investments they have made on their own medical
education, by fleecing patients. So there is often an
unholy nexus between such doctors, the testing labs
and the agents for medical firms who peddle the more
expensive medicines. The more glamorous hospitals with
better facilities, that are all supposed to provide
some proportion of free care to the poor, have proved
to be remarkably adept at evading this legal requirement.
So poor people rarely, if ever, get access to them.
But even the government hospitals are hard to get into.
Furthermore, they are hugely demanding of time, which
is one of the most expensive things even for the poor.
Outpatient visits typically require at least a half
day's or even a full day's leave because of the long
queues involved. Inpatient care is even more demanding
of the time of the patient's family.
Since the government hospitals are so short-staffed,
they function according to a system whereby nursing
is relegated to the bare minimum. So each patient must
have an attendant at all times, not only to do some
of the things that nurses do in hospitals elsewhere
in the world, but also inform the ward nurses of the
patient's condition, buy medicines whenever necessary,
and so on.
This means that even in poor families for whom daily
wages are the main source of income, a family member
- typically an earning member - will be forced to spend
the entire time at hospital with the patient. Usually
there is next to no provision for the needs of the attendant,
who will have to sleep on the floor of the general ward
and find food and other necessities somehow. The sight
of patients' attendants and families stretched out on
the floor of hospital corridors, with their hampers
of food and basic clothing, is now so common for us
that we barely notice it. But it would be unthinkable
in most parts of the world, include in most of Asia.
Somewhere we have lost our bearings, as a society, since
we allow this appalling health system to continue and
even get worse. If we do not address this most basic
of social issues, the chances are dim of us getting
anything else right.
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