[State of Nation’s Health] WHO CARES?

The media is currently rife with the debate about the exorbitant billing made by a five-star hospital in Delhi to the father of a young girl who succumbed to her brief illness. But is it the right debate? Are those throwing stones at the hospital not the kind who go to private hospitals themselves? Is it okay if private care is affordable and not exorbitant? At an individual level, I do not and would not like to ever submit myself to private health care. It is because I believe that medical care must never be treated as a commodity and must be available to every human equally.

Is it okay if private care is affordable and not exorbitant?

Isn’t it often that we see ourselves and our friends looking the other way when we come across someone ailing on the street or in our neighbourhood? Even if we don’t do so, we would take her to a place where we don’t have to foot the bill or do not have to pay too much. Surely, we would not take the risk of taking her to the best possible facility, where we hope to take someone from our own family when she is ill. When we do not respond to someone else in her hour of need it, it kills a wee bit of the human inside us. At such times, when we differentiate one life from another, we help kill the human inside us – and forgive ourselves for it – and help create a society that doesn’t care. And I believe that is what is wrong with India. As a race of people, we have stopped caring for each other.

With an apology of a public health system in most parts of the nation, this callousness inside us towards life happens again and again, and humanity in us gets horribly damaged and we gradually stop caring for each other. We may use the terms antenatal care, neonatal care and Intensive care in medicine, but most people would agree with me that though some procedures are carried out in their guise, one misses ‘care’ in them.

As a citizen of a country that is in the top 5 economies of the world, that has been the largest importer of weapons in the world for the past decade or so, that has the technical knowhow to launch the highest number of satellites through a single rocket, and that has the most brilliant IT workforce in the world, why must I be subjected to the ignominy of a record that we have almost a hundred and fifty times more women dying during pregnancy and childbirth than has been achieved in the world. Why must I know that 3 or 4 percent children must die in my country every year before they celebrate their first birthday while even our poor neighbouring countries save more children

Why can’t the government nationalise the health industry and utilise all the lovely facilities for ALL and pay the owners their 10 or 20 percent costs?

Why should there be a system or the lack of it in this country of mine because of which a poor person gets no treatment or a very inferior kind of treatment compared to a rich man? Those who say that we must learn to accept inequality in life and how it treats someone as an inevitable, I would ask them to go visit the medical services. I worked for over 10 years in the Army Medical Corps and despite the military being the most hierarchical of organisations, not once in those 10 years did i hear any of my colleagues decide the line of treatment based on the rank of the patient. An officer and a soldier may be housed separately in different wards, but to think of a more expensive line of treatment for a general and not for a soldier, would simply be impossible to conceive of even today, 23 years after I resigned my commission. The Army has different types of uniforms, epaulettes, quarters, perks and diets too, but It is with this fell stroke of equality that the medical services in the Army give to the lowly soldier the dignity of being human and the message that it CARES! And that is one thing that the Indian health system DOES NOT do. Paid wards, differential of services between those who have and those who do not, those who are insured and those who are not, has widened the gap between the haves and the have-nots. In fact, all but the poorest of the poor have abandoned the public health system in favour of a private for-profit system that is unethical at its best and bereft of science at its worst!

A few years ago, i had to rush to Delhi where my father, a retired Central Government employee and a freedom fighter to boot, had been admitted to a five star hospital in an emergency because that hospital was empanelled and he could get treated free of cost. At the time of his discharge, as an attendant i was asked to testify to his billing so that the hospital could submit it to the government for reimbursement. I was surprised to note that the rates charged to the Government were only 10 to 20 percent of the rates charged to the general public, clearly indicating that just an increase in utilisation of the same facilities could bring down the prices of medical interventions by 80 to 90 percent. Having been associated with the voluntary rural health sector for almost 3 decades and having procured and prescribed generic drugs, i also know that i can buy good –quality generics at 5 to 10 percent of the MRP printed on the best brands of the same medicines. So, here is what I would like to ask: Why can’t the government nationalise the health industry and utilise all the lovely facilities for ALL and pay the owners their 10 or 20 percent costs? With just this one announcement, it would be able to announce to the entire country that it CARES FOR ITS PEOPLE! This would also help us all preserve and nurture the humanity inside us that defines us. It would also help people reach hospitals earlier and faster because they would be able to afford care and people like us would also not have to think twice in taking them to a hospital. It may bring about a change in our attitudes and teach us once again about how to care for each other. And maybe, once we get assured that the nation cares for us, we may also care for our country beyond standing up during the anthem and cheering for our cricket team against you know who!

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Dr. Sunil Kaul Written by:

Dr. Sunil Kaul completed his MBBS in Pune and served as a medical doctor in the army for some years before he went on to become a public health activist. He worked in rural Rajasthan and Assam especially with respect to malaria and T.B.. He is the founding trustee of The Action Northeast Trust (ANT). He has an MSc in Public Health (in Developing Countries) from the London School of Hygiene and Tropical Medicine and a faculty member of Institute of Development Action (IDeA). He is also Financial Advisor of Aagor Daagra Afad, Trustee at Lowcost Standard Therapeutics, consultant to Community Health Initiative of Meghalaya, Rural Development Society and Advisor (Assam) to the Commissioners for Right to Food. He lives in Rowmari in Bodoland, Assam

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