Thappad- Indian Healthcare: The underwear that we have to hide.

Raj was tired. Anyone would be, after a full twenty four hours of work. All he remembered was crawling under the bed of one of the patients in the ward and closing his eyes. The stethoscope lay over his throat, like a robot snake.

“thwack!” It was a kick to his chest. “Ou!’ Raj cried in real pain.

The final year Resident had come. The chief was coming for rounds!

The final year pulled up Raj from under the bed.

“YDog! A@#@##e! What the $$^k are you doing?” The final year shouted.

The pre rounds were not taken. Blood samples were not drawn. Reports not collected.

Raj struggled groggily to his feet, apologising even in his half-sleepy state. He clutched at the side, where the kick had cracked a rib.

“Thaapp!” The final year slapped Raj full across the face.

This is a scene from one of our famed public hospitals, right in the Indian heartland.

Unbelievable? Believe it.

Raj left his residency after two months. Next year, he joined the same speciality as first year in JIPMER, where I met him.

Stories like this were routine. I have friends who have trained in almost all the major public healthcare centres in India. The picture is not pretty, believe me.

Patients get slapped too. In more than one place, the consultant will thunder into the ward, and fly into a rage if patients with bedsores, necrotic wounds and difficult diseases are admitted. It is the duty of the Resident to ensure that they run away.

In one of the most prestigious municipal tertiary centre in India, as one consultant barges into the hospital for rounds, desperately ill patients are put on trolleys and wheeled into the corridor, out of sight of the boss. Later, these patients are subjected to intensive counselling. The residents often collect money to finance the poor patient’s return to their native village.

“Here, you won’t get much care. You will lose all your money. We will give a letter to the local doctor.”

I don’t believe these were without the knowledge of those in charge. It was incredibly convenient to turn a blind eye.

Another of my friends joined a hospital in a state known for discipline and righteousness. The local students thrashed them badly with the collusion of the authorities. Many ran back to their parent states. The seats they vacated, the local students could occupy.

My friend went back. Braved everything and completed the course. I salute him.

He was a mild and sensitive soul. Three years hardened him. He became as stiff as an iron nail. If the purpose of residency is to leech humanity out of people, and toughen them, they succeed beyond all imagination.

This friend described to me how he had to forge the seals used by the hospital lab, and learn the signatures of the technicians. This was the first lesson taught to first year residents. Then they would, most of the time, forge lab reports, before the boss came for rounds.

“It was impossible to get the reports on time. You will get shouted at if it is not there.”

“Couldnt you just tell them, the truth?”

“Come on!” He looked at me incredulously.

India spends less than one percent of its GDP on public health. Three percent overall, including private, and seventy percent is by out of pocket spending by our poor population. A large chunk of healthcare is provided by quacks who have no degree, or AYUSH practitioners who practice Modern Medicine.

Europe spends 10 to 15 percent. USA spends almost 15 to twenty percent, and it would surprise you, that almost half of it is spent by the Government.

Consider the fact that per capita income as per PPP is ten times less for an Indian, when compared to a European. In some places, up to twenty times less. So ultimately, the health of an Indian is one hundredth the value of that of person in Europe!

We are not a rich country. But even within our constraints, we could have done better.

 Health care, and basic education is the platform on which we can build a proud nation. Reasonable dignity and equality for all- at least we should try for it.

This is like underwear, over which we put our dhoties and saris.

Any crisis, like the present Pandemic, can blow away our dhoties. Unless our undergarments are on order, how can we stand our ground?

The doctors too, are to blame. The Council, which had a well deserved death, had real power. When did it ever address the issues facing the Nation?

Just look at our residency programs. DNB is any day, better conceptualised, and free from corruption, than MD programs.  Why do you want a medical school in the same campus to train a Resident? Where else in the world do we have such a requirement? This is just one example.

When were we ever bothered about Primary Health Centres and sub centres not having enough doctors or facilities? Did we come with basic guidelines that were resource appropriate? Did we train local nurse practitioners and midwives enough to adequately address the need?

No. We didnt.

Dont ask me what I have done. I haven’t done anything.

At least I can shout. Tell this ugly truth hiding in plain sight. Keep creating buzz. I think it is time that we did.

The prod for this piece is a report by a committee on Covid management in one of the highly affected areas. It touches a bit on the plight of residents, nurses and other personnel involved in the work.

I don’t want to get into the details. This is not the time. Let us wage war together, with whatever we have.

But, when in the heat of the battle our dhoties fly off, we should have had that underwear firmly on.

I hope that this crisis teaches us a lesson. It is possible to be better, and we can do it. But the first step is to call out, when things are not good.

Shout, when we have to. (Jimmy Mathew)

Dr Jimmy

I am a Doctor, Writer and Science Communicator. I am a member of Info- Clinic, and have written a few books. This site features my blog posts and stories. Thank you for visiting. ഞാൻ എഴുതാൻ ഇഷ്ടമുള്ള ഉള്ള ഒരു ഡോക്ടർ ആണ് . നിങ്ങളുടെ താത്പര്യത്തിന് നന്ദി .