Health of the Public Health Services

I was trying to fall asleep in the middle of the slightly overcast humid night, lying in a corner of the bed; my eyes were glued to the metallic ceiling fan, radiating the dim green light of the night bulb falling on its rotating blade. Unknown fears that had imprisoned my grey cells for long, stood in my way to embrace the sound and soothing sleep. Suddenly my cell phone rang, sending jitters down the spine. It was a call from my friend, alas; her father had the stroke like symptoms and is being rushed to the medical college hospital. My mind went numb for a few seconds; I gathered all energy to pull myself out of the bed and raced towards the hospital. On my way to hospital, I tried calling the doctors I knew or could think of at that moment of shear helplessness.

Mere sight of the emergency ward was horrifying; patients stained in blood crying with pain and agony. Maneuvering the crowd of anxious attendants and wailing woman, I found her father lying on a stretcher in a corner of the emergency ward, being attended by a doctor encircled by the flustered family members.

Medical college hospitals are not known for the agility and quality of the services they offer, thankfully, my brother had already spoken to the doctors on duty and who in turn ensured that all the necessary tests and monitoring are done. After spending two terrible hours, doctor advised us to transfer the patient from emergency to CCU ward.

CCU is a small glass room comprising of approximately ten beds for the patients who need critical care. It was shocking to see the state of the place reserved for the patients with critical conditions; healthy mosquitoes were singing and dancing in full spirit, glass door was oscillating on its hinge, making irritating sound each time a person entered and left the room. Just outside CCL there was a thick layer of dirt and filth spread all around. People distressed and exhausted by the tiring day were sleeping on the floor with the exception of some blessed souls who could find the makeshift beds. Toilets were stinking and squalid; it was almost impossible to use it without turning off all the five senses given by God to feel the world around.
Night was horrible, it was passing like the sand trickling down the sand glass and I felt like counting the imaginary sand. I went to the attendant on duty to enquire about the patient’s condition; he was a relatively young guy, frank and forthright, trying his best to sound intelligent using the difficult technical verbiage. His counterpart nurse seemed to be engrossed in a never ending telephonic discussion, occasionally disturbed by the anxious attendants. She felt annoyed and angered, when I informed her that oxygen does not seem to be flowing in the pipeline that is causing serious breathing problem for the patient. Thanks God, she moved a few inches and could make the necessary arrangements.

Next morning(working morning which does not include Sunday), cavalcade of doctors led by two gentlemen in darks suits and colourful ties (apparently senior doctors) came for the check up and review. It seemed to me nothing more than the perfunctory and mechanical orchestral performance that sans genuineness and empathy. They advised for a couple of tests after speaking to fawning junior doctors exhibiting their readiness to crawl when asked to bend very much in line with the great Indian tradition.

After spending four harrowing nights at the hospital, he was discharged in much better condition though disease cannot be diagnosed. It was not possible without the help and guidance provided by the doctor friends. For those who are not so lucky, it could have easily taken weeks or even months

After regaining a bit of strength, we took the patient to another doctor in a private hospital for further investigation as advised by our doctor friend in the medical college .This incident disturbed and depressed me immensely, primarily because of the callous attitude of the hospital management towards the weaker section of the society who cannot afford to go to a good private hospital. Hospital support staffs in general were rude, insensitive and notably careless. I lost my calm and composure, and just stopped short of slapping the ward boy when I saw him shifting a patient from bed to stretcher like a lifeless object.

Three days and four miserable nights spent in medical college hospital confirmed my apprehension that “Hospital Management is indeed like a rudderless ship with no sense of direction and purpose”. Significant symptoms of management illness were ubiquitous like the suffocating dirt and filth spread across the length and breadth of the hospital. I must appreciate the unwavering spirit and indefatigable energy exhibited by the junior resident doctors to make the hospital functioning. Perhaps, it is the only silver lining visible in the dark clouds of despair and distress.

Public health system in India is catering the vast majority of the low income population. It has crumbled due to lack of infrastructure and trained medical professionals, wide spread cancer of corruption and incompetent management abetted by the insensitive government democratically elected by ‘We the People of India’ .Gravity of the situation are better explained by some of the heart wrenching facts such as ‘Around 3 million people are suffering from HIV and 2 million children die every year from the easily preventable diseases’.

There is a paradigm shift in the health policy of the Government of India. It has changed from being a ‘comprehensive universal healthcare system’ as defined by the Bhore Committee (Health Survey and Development Committee, under the Chairmanship of Sir Joseph Bhore, submitted in1946) to a ‘selective and targeted programme based healthcare policy’ with the public domain being confined to family planning, immunization, selected disease surveillance and medical education and research.

Collapse of the corroded structure of the public health care services has allowed private health care services to flourish unregulated that often leads to the exploitation of the patients. According to the World Bank report published in 2002, irrespective of income class one episode of hospitalization is estimated to account for 58% of per capita annual expenditure, pushing 2.2% of the population below the poverty line. Even more disconcerting is the fact that 40% of those hospitalized had to borrow money or sell off their hard earned assets.

Captains of the industry who are fascinated by the potential growth opportunities offered by the health sector are at best indifferent to the plight of the fellow Indians. The great Indian upper middle class excited by the McKinsey prediction of mammoth growth in fledgling health care sector are equally concerned about rising cost of health services. Helplessness of the fellow brethren who die silently in the secluded corner due to apathy of the state towards the health care services does not grab the national headline. English speaking new generation who claim to be the harbingers of shining India are too busy to think and talk about the trivial issues.
Alas -these pain and angusih have been aptly expressed by the great urdu poet Zauq in his famous couplet:

'Duniya ne kiska raahe-fana mein diya hai saath
Tum bhi chaley Chalo yuhin jab tak chali chale'
(Who's come to the rescue of some one who's about to leave the world!
You too keep moving till you can move on)