DOCTORS!!

 The complete write-up

Aamir’s show this Sunday was on health care and health care professionals in India. And the tone was justifiably negative.

Pathetic – the one word that can define the state of affairs. There have been raging debates on the issue; there would be volume-loads of literature being written in the future, but what would be the point to begin that would bring the change, had the answer in the show itself. The answer has been all around, much debated and discussed but not able to find takers at the top-most policy-making level.

Aamir was reacting on every small fact, known to millions and already in the public domain, in a way like it was a bombshell. And this sort of attitude (unawareness) is exactly the problem.

Now don’t we all know how the many doctors are cahoots with the marketing machinery and the exacerbated human greed?

Most of the doctors in the government hospitals complete writing the prescription slip even before the patient finishes his account of the problem. Private doctors are not within reach of the majority. Those, from this lot of majority, who approach such doctors, either take loan or kill their savings.

It is next to difficult to convince most of the doctors to write medicines easily available at most of the chemist shops.

It is almost impossible to ask a doctor to let you follow the diagnostic centre that is convenient to you.

Doctors sustain lives. They are supposed to be next to the god. They why this?

Go and experience it. (I bet many of you would already have something to share.)

Recently, I had ligament tear. After trying self-healing, I approached a nearby hospital run by a charity governed by Delhi’s health minister, Ashok Walia. The doctor recommended X-ray and asked me to come with the report. The X-ray guy was probably in some other world as he clicked for wrong part of my foot. I had to get it redone. After it, when I approached the doctor, he had serious expression on his face and some heavy words ready for my problem. He explained it at length like I was having some serious fracture. He wrote three days of medicine and advised to consult again. When I tried to purchase the medicine from the shop I am regular with, I couldn’t find it there, not even at any other shop in the area. Some of the shopkeepers advised me to approach the pharmacy of the hospital. And lo! I got it.

But see what I got it. These were generic salts marketed by some unknown Delhi based company but with almost equal price tag as the branded medicines. They didn’t work on my pain and I left taking them after a day. Anyway, my problem was gone three days after visiting the doctor when I had an enjoyable 4 kilometers walk back to my home.

Now if this is the state of affairs of a charitable hospital associated with a name that is Delhi’s health minister, we can easily imagine what is happening all across.

Magnifying the problem, writing medicines not really needed, and writing highly-priced ineffective versions of medicines – indeed a crime.

I can say I have come across multiple such examples even with the famed doctors indulged in such malpractices. (And I am sure, there would be many like me.)

Another bad patch is the excessive charges being levied on. You can easily find the sky-high differences in the cost of diagnostic tests of different labs. Last year, my sister had a mild fever but the doctor at the Max hospital wrote medical tests for almost everything with bills running into Rs. 20,000 plus figures. My sister recovered after three days and had no need to follow the medicine regime advised for 15 days. Doctors get huge commission on the medical tests recommended, even at the big hospitals like Max and Fortis it seems.

And the commission system really kills. Your hard-earned money goes into nothing.

Extending the tyranny is the unaccountable costs incurred on hospitalization. When I had met the doctor for knee-cap replacement surgery of the 76-year old Mrs. Mehta, I was given a cost-estimate of Rs. 4 Lakh. The total funding generated was around Rs. 5.5 Lakh. And though it was an acclaimed hospital run as a registered charitable institution, the final bill amount crossed the Rs. 5.5 Lakh limit. Okay there might be genuine additions, but what I observed about the attitude of the support staff; it was not different as the money-soaking practices exercised by the corporate hospitals and other notorious one/two doctor nursing homes.

The focus was on maximizing the bill amount irrespective of the need.

There are good and bad people in every profession, but certain areas, owing to their emergency nature and poor access to the public in India, creates an easy ground for manipulation, and health services in India is one such area.

What aggravates the misery in India?

Almost half of the population illiterate (with even greater share of medically illiterate lot), over 65 per cent of the population below poverty line, an ever-increasing urban slum population, lower number of even the allied health professionals working in the rural areas and the restricted availability of qualified medical professionals to the large sections of the population even in the urban centers are the telling signs of the malaise. I don’t need to write the statistical base for all this. Most of us are aware of these.

Unawareness on health care rights and poor government spending on healthcare amenities by the government at the cost of promoting private enterprises coupled with the problems mentioned above create and sustain the monster.

I have been working with doctors and activists. I have come across few good doctors. They are really serious about bringing the change. But I can say I have come across more bad doctors. The condition is frightening in rural areas.

Like I wrote in the beginning of this article, the answer lies in the show itself. It doesn’t mean the show had some miraculous remedy.

It’s ‘attitude’ my dear friends.

Like Aamir was reacting, as if it was a revelation, on every bit of information already in the public domain (at least, victims do feel it all the time – and majority of the India has been victim of the miserable health care system), it is almost same with our policymakers.

The difference is Aamir is trying to do something while our politicians prefer not to do anything. One might be unaware owing to his upbringing but the other lot prefers to remain unaware. 

Unawareness that is going beyond all the acceptable limits!

Policies for the larger India – poor, battered, cursed to live in dark and silence – are framed in closed doors of granite glazed and Italian marble carpeted rooms of Delhi and the state capital cities.

And the current breed of our policymakers look awfully insane when it comes to framing policies reflecting the need of the Indian on the street, be it mapping a village or a small township or some large urban centre.

Either they are career politicians, cushioned in the Parliament for decades, who have comfortably forgotten the miseries being faced daily by an ordinary Indian; or they are the heirs of the political dynasties born with the silver-spoon; or they are rich industrialists or celebrities like Vijay Mallya or Jaya Bachchan, not in touch with the grass roots social needs; or they simply represent the increasing number of politicians loaded with criminal cases against them. The current breed has very few of the politicians who represent a self-built career on social needs and grass-roots level politics.

And health care rights are one major victim of the increasing policymaking paralysis due to the insensitive politicking most of these politicians exercise. Health care services are one of the major sources of corruption given the huge capital and deliverables involved. NRHM (National Rural Health Mission) is one of the biggest scams in the Indian administrative and political history.

And why it happens. Again the unawareness factor!

Most of the Indians even in the urban centers are not aware of their rights (owing to the various socioeconomic maladies mentioned above) resulting in the open loot by the doctors and government officials. It is an open fact that no one want to visit a government hospital to consult a doctor. Only compulsions force patients there. The misery is in calamitous proportions in rural and tribal areas. How can we forget that our great democracy incarcerated Dr. Binayak Sen for over three years for raising voice for health care rights of tribal and rural people?

Health care (like other killing issues, i.e., literacy hunger, etc.) is in shambles in India and needs an immediate swipe but, again, the million dollar question, is, HOW? Let’s see how the ground realities stack up:

A UNICEF report says one in every three malnourished children in the world lives in India. The report further says, “In India, around 46 per cent of all children below the age of three are too small for their age, 47 per cent are underweight and at least 16 per cent are wasted. Many of these children are severely malnourished.

Malnutrition in India is roughly around 46 percent. It has fallen only six percentage points since economic reforms started gaining pace in 1991 while the GDP per capita boomed by 50 percent during the same period. It clearly shows increasing social disparity with majority still living at the bottom of the pyramid.

Government of India defines coverage area of a primary health centre to be 100 villages and 100000 of population by one doctor. According to a report, 64.9 percent of community health centers report lacking specialists while 68.6 percent of PHCs function with only one or no qualified doctor. Also we can understand the negligence by the government machinery as public expenditure has stagnated at just 1 percent of GDP over the last two decades against WHO’s recommended 5 percent.

According to 2006 figures, doctor to population ratio in India was 60:100000 (.24 dcotors per 400 of the population).

Do these figures tell something? YES!

Do they buzz on the ears of our policymakers? NO!

Dear doctors, at least, you do something. Ask your brothers and sisters to be brotherly and sisterly with other fellow Indians.

I firmly believe there are many 'Dr. Binayak Sens'.

The need for something to be done is urgent. This article is not inspired by the TV show, yes but it stirred me to write on the issue. We all need to feel, and more importantly, act.

For the moment, the solution remains elusive, like the spirit of our democracy, like the soul of Mahatma’s ‘Ram-rajya’.

©/IPR: Santosh Chaubey - http://severallyalone.blogspot.com/