Why public healthcare is making India eat from the floor

The recent picture of a patient at Ranchi Institute of Medical Sciences (RIMS) eating food served on the floor stirred social media outrage. People deplored government apathy towards public healthcare services. But the social media noise around the picture in question lasted for barely a day.

Arnab Goswami too seemed very busy with his anti-Pakistan stance and other channels continued to stick to their agenda. Nobody wanted to question the ailing public healthcare system in the country. After all, in the era of TRP and readership-driven journalism, who cares for the crumbling health infrastructure.

Sensational reportage overpowers sensible reportage. Social activism, however, is considered a waste of time.

Therefore, that woman who deserved a clean plate of basic dal and Chawal at a government hospital was served on a dirty, infected floor and we moved on after a brief bout of social media protest.

The image of this woman brings in perspective the state of affairs at all government hospitals, including our premier medical institute AIIMS. AIIMS being AIIMS gets 10,000 patients at the OPD on a daily basis. Most of the patients gather outside the institution at 3am in the morning and wait till 8pm in the night to meet the doctor for five minutes. During these 15 hours, they are either sitting outside the gate, on the pavement at Ansari Nagar, or keep standing for their turn. Mostly, a security guard shoves them out to avoid rush outside the OPD.

I have been to AIIMS a couple of times in the last four months for the routine health visits of a near and dear one battling cancer. Every time I visit the hospital, my heart goes out for the little bald kids, with a central line pierced through their neck or chest, waiting for their turn to get chemotherapy.

One such patient who caught my attention must be around seven years old. She had lost all her hair, turned into a bag of bones post the first round of chemo and was waiting for her next round as soon as she found a bed. It had been three months since she and her poor parents had parked themselves outside the hospital in the hope of getting her admitted soon.

When I spotted her, she lay on the floor, with an empty bottle of a cold drink under her neck for a pillow. Her mother said that she puked every time she put her head on the floor and needed a pillow to support her neck. That sight broke my heart. It has stayed with me since. Despite trying hard I could not come to terms with any argument that might explain why AIIMS continues to be a painful experience for every patient who relies on this premier institute for relief and recovery.

While the swelling number of patients visiting AIIMS from all over the country and the neighbouring nations is definitely one of the factors leading to more chaos at the institution, there is no denying that precious little has been done by the government to deal with this issue.If this is the state of affairs at AIIMS, I wonder what patients have to go through at other government hospitals! As a result, patients depend more on private hospitals for better services and facilities than government-run hospitals.

The growing dependence of Indians on private hospitals over the last ten to fifteen years has only escalated the pain of the patients - and on a different front. The exorbitant fee structure and unfair pricing of medical facilities has burnt a big hole in the pockets of average service class population, who somehow manage to pay these huge bills in order to avail timely medical attention for their kin.

Recently, a family member fell sick post chemotherapy. The usual effect of chemo on the patient is reduced immunity and an abysmally low blood count. She was admitted to Max Hospitals Gurgaon with high fever and an abscess in the glutel region, with her platelet count sitting at a mere 20,000. While she continued to have high temperature and pain, the doctors did not feel the need to discharge the abscess to relieve her of the excruciating pain. The hospital, however, discharged her on the third day without resolving the issue. 

A day later, her fever shot up to 104.7 F, and the abscess that the team at Max didn't feel the need to drain had turned huge and unbearably painful. She was taken to the same hospital again - this time in an ambulance. On arrival, the emergency doctors rushed her to the ICU and suggested a surgical drainage the next morning, supervised on general anesthesia. Since early morning the next day, the family member was kept without a drop of water to ready her for the surgery planned at 10am.

The doctors asked us to arrange platelets since she was low on them. While we were arranging platelets and taking the donors to a nearby hospital (Max Gurgaon doesn't have donation facility), the doctors called us to the ICU and informed us that it is extremely risky to operate on a patient with low platelets, and that they do not have a negative pressurised room to keep the patient isolated to prevent infections. We were advised to move her to another hospital.

At that time the only question we asked them was - why weren't we informed of the same last evening when we rushed her to them? Didn't they know then that her blood count was low and they didn't have the isolation facility?

Despite our escalating the matter to the MD and having spent two hours explaining how we felt harassed by the lackadaisical attitude of the doctors and the other staff, he did not relent. When I said I was an aggrieved consumer and that the law of the land allows me to take my grievance to the court, he yielded. I had every document to support my argument.

My family member was operated upon after on the third day after a long ordeal.

At the time of the discharge, when we scrutinised the bills, we realised that they had quoted huge figures for nothing. For example, we had to pay for a doctor's visit twice in a day. Also, we paid for doctors we didn't even see in the ICU. A sugar test, urine and blood sensitivity tests were done daily for no rhyme or reason. Every aspect of the bill was questionable. The hospital management was unapologetic and offered to deduct Rs 5,000 from the bill, which we refused to take.

Such is the state of affairs of private hospitals who, owing to the lack of robust public healthcare system in India, are becoming money minting entities as opposed to acting socially responsible. A couple of years back, honorable Supreme Court had criticised the private hospitals for acting like five-star hotels.

In its observation, the honourable court had also questioned these hospitals about their promise of providing 25 per cent outdoor patients and 10 per cent in-patients free medical service in return of the lands given to them at throw away price by the government.

While there is ample anguish the common man nurses against the private corporate hospitals, the real culprit here is the fact that the government never really prioritises health over other sectors while drafting the annual budget. The minimum budget for public health should be at least three-five per cent of the GDP and we are nowhere close to that.

How would a nation progress with a population battling serious communicable and non-communicable ailments with a crumbling public healthcare structure and a private healthcare infrastructure that is getting more expensive by the day in the absence of any monitoring system?

Those who are affluent can afford both private hospitals and also manage to get a bed at AIIMS, those who are poor either resort to alternative therapy to prolong their life expectancy or perish, and those who belong to the middle class have no choice but to burden themselves with loans to pay exorbitant medical bills at these corporate hospitals.