Sunday punch in Public Healthcare
Author: Dr. Jakir Hossain Laskar, PhD
[ Private medical establishments are playing ducks and drakes with the helpless common folk ]
Government sponsored medical system in our country is fallen in profound critical situation. Governmental health-care infrastructure is about to break. Hungry India is taken aback in health and education. The condition of medical education is also extremely disorganized and in total disarray. Govt. has no concern to bring the renowned professors in the worn-out medical education. Emphasis in almost all provinces is being given on non-governmental medical infrastructure. Big political leaders and ministers today have no spare time to cudgel their brains about the health facilities of hundreds of thousands of poor starving common-folk! Step by step, so, the Central Govt. and all state governments have engaged doggedly to complete the process of inclusion of the poor people in the non-governmental healthcare industry having disorganized the govt. sponsored medical infrastructure subtly and on the sly. But, if the elected governments do not pay heed to the health problems of the poor and the low income group, then who else will espy? We need to have more professionalism to run the health department and its subordinate hospitals smoothly. And in the governmental system, this professionalism is quite possible to bring. But, the govt. in various pretexts is giving the chance of playing gamble with the community health to the non-governmental medical corporate organizations.
In 2010, according to the investigation jointly done by UNDP and Oxford University – the number of poor people in 8 states (Madhya Pradesh, Bihar, Chhattisgarh, West Bengal, Jharkhand, Uttar Pradesh, Orissa and Rajasthan) of India is more than the total poor population of 26 African nations. Roughly 16 percent of total population of the world lives in India but according to nutrition measuring rod “Body Mass Index”, more or less 37 percent Indians are the victims of malnutrition. Almost 45 percent infants and children under 5 years of age of the country are continuously undernourished. More or less 50-55 percent scheduled castes and tribes are also having lack of nourishment. According to the World Health Organization (WHO) standard, if 40 percent people of any community are undernourished, then that clan is considered as famine-stricken. So, the tribal society of our country today is seized by famine according to this definition. Then, how long will the so-called philanthropic Central Govt. and all the state governments of various political descriptions wind up the business? Don’t they know that the socio-economic prosperity of any community has direct relation with their good health conditions? I consider, not only those who are in below poverty line – rather all the citizens of the nation should be brought under the rationing system, because, if all the people stay in the same system, mass-consciousness is increased about that system and its efficiency is ubiquitous as well. This extreme poverty of the vast concourse of people in the country – its consequence is only a dreadful health-disaster – which is practically nothing but a big genocide.
In any country, if the good result of education, health and poverty-eradication is not made to the all walks of life realize – the confirmation of socio-economic development of that nation is not possible. So, the object of the Govt. of India should be the time-bound overall improved standard of living of the great multitude of common people, only the increase of personal earnings and aslant economic development is not desired. According to the opinion of United Nations, desired advancement couldn’t be occurred in India in the sector of health and education because of shortage of food-grains and curtailment of budget proposals seriatim in the public interest sectors, such as, education, health and infrastructure development, etc. Food security and the right to having food in our country gradually have become political issues and the food security law has been confined only within the electoral promises. Because, in spite of increasing national per capita income since last two decades, no central government till date betimes did pay heed to this common peoples important burning problem of food security. Almost every government has also been foiled to confirm the supply of daily food-stuffs for the masses. On the contrary, the entire nation is heading towards a form of uncertain crisis because of under-nourishment, intaking of low-calorie per capita diet, giving birth under-weight baby and increased death-rate of emaciated malnourished children. This panic-stricken fragmented picture has been cropped up from the information given by the “National Family Health Survey” (NFHS). According to the report of “Food Hunger Index” under “International Food Policy Research Institute”, our state of Bihar or Jharkhand in the rate of price of shortage of food-grains is for more behind Haiti and Zimbabwe which are very poor countries. Our Madhya Pradesh is also far behind from ever-deprived Ethiopia. A general section picture can be gotten from the report of “National Family Health Survey” which corroborates the nationwide created health-crisis because of non-availability of food-grains. This survey is making us known with great concern that, according to “Body Mass Index”, 37 percent female and 29 percent male are undernourished in comparison with the necessity. Roughly, 47 percent infants and children under the age of three are malnourished and 56 percent pregnant women are also stricken with anaemia. Besides urban health crisis, rural health-scenario is also how much cruel and hard -hearted, we all know! How much economic advancement be occurred in India, we are far more behind in over-all standard of living along with proper community health. India’s position is still 119-th according to “Human Development Report (2010)”. In spite of having 8.9 percent economic growth, the nation is almost stagnant in the field of health and education for the futility of poverty eradication.
In almost all developed countries there is a custom of making the patient and his / her relatives understand about the type of the disease and the procedure of treatment. In those countries, printed medical booklets are available about the diseases to make the patients understand. Pamphlets printed in various languages are also given to the operation patients so that they can live healthy life without any post-operative complications. But, unfortunately, this is not in vogue everywhere in our country! Though, it is possible for everyone if treatment-related any matter is made understand generally and clearly. But the main point is how easily the attending doctor can make them understand. Who is made understand, his educational qualification or social status has nothing to do with this understanding. More developed treatment procedures need to be introduced in our country for innumerable chronic complicated diseases harmonizing with the ever-changing situations in the field of medical scenario. Because of higher researches in Pharmaceutical Industry, many new medicines have been invented. Operations would have been done beforehand in those diseases, now, may be, those illness can be cured only with the administration of oral medication. When any of your kinsman is admitted to the hospital being seriously ill – you’re to spend the whole day in and around the hospital premises with great anxiety, but you’re not informed what has happened to the patient and what steps are being taken for his or her treatment! Though you’re entitled to know about the type of disease. Attending doctor and treatment-providing respective authority should discuss about what measures can be taken for treatment after the diagnosis of the disease with the patient and his or her family-men and further course of action should be settled after due deliberations. In it, kinsmen of the patient can well understand what has happened to the patient, what sort of treatment will be required, how long it will take for his convalescence and also they can guess about the approximate medical expenditure. And thus many unwanted misunderstanding can be averted between the patient party and the treatment-providing authority. But in our ill-fated country, greedy avaricious doctors don’t feel the necessity of giving the answer to these inquiries and eventually a middle-class family is utterly ruined being squeezed in the illegal grindstone of medical system.
In most of the developing countries, the number of doctors is dearth in relation to the population density. Yet the mother and child death is possible to minimize with the indigence of doctors. A nation where there is dearth of doctors, midwives (nurse-mothers) may be auxiliary in this regard. Developing Countries like Sri Lanka, Malaysia and Thailand have been able to minimize the death-rate of mother and child. However, my country is yet lagging behind unfortunately. The entire world knows about the trained and adroit Swedish midwives – those who are not like fourth-class staff of other countries, they are one of the well-respected professionals in this society. There is no other course left open except making the professional cadres of midwives to facilitate safe parturition. I think the relation of cordiality and professional co-operation should be maintained between the doctors and midwives. Also, midwives should be given power to run the labor department independently taking consultation from the deft obstetricians. Because, midwives have saved the life of our mothers across the century; many vivacious infancy are being in debt to them. I’m sure, our trained midwives will be able to run various midwifery-related clinics completely, such as, pre-parturition nursing, preparation of child-delivery, neo-natal nursing, family planning contraception, abortion, even the special emergency clinic for rape-victims. Our discreet far-sighted central govt. does start thinking of using of nurse-mothers for safe motherhood.
Medical education also in our country is thrown into confusion – to run this field successfully, such type of high-souled people are required who are in no way subservient and not bound to carry out any political party’s order. Forming a “search committee”, methinks, good doctor-professors may be brought to steer the health universities, and for teaching in medical colleges. It’s a matter of sadness that transfers and promotion of govt. doctor-teachers are done according to the reward of allegiance of a particular ruling political party. Doctors are appointed in the medical administration and in health universities in accordance with the political approbation. Thus uplifted medical education system has been neglected long time in our country. Our central govt. and all other state governments consider treatment of the patients foremost, medical education to them is secondary. Medical colleges or universities are not given independence regarding selection of professors, appointment or transfer. There are shortfalls of medical library, laboratory, hostels, lecture theatre, etc. in comparison with number and standard various colleges. Pathology and radiology departments in many colleges across the country are limping, what to speak of talking about dearth of professors. However, if our government genuinely intends to bring back plundered glorious excellence of medical higher education and treatment, the incumbent govt. should take exceptional assiduous endeavour, like forming “mentor group” appointing proficient doctors and medical professors from across the globe – because, in the retrieval and resuscitation of educational heritage, medical higher education cannot be neglected. Public health engineering and medical treatment based on rural health centres throughout the country in first 25 years after national independence became exemplary to the rest of the world. Many eminent doctors of today started their service life in those primary health centres. But, a state of turmoil and anarchy became prevalent in the national health scenario from the decade of eighty. If, today, the environ of work by the doctors is not changed, the entire health scenario will never be transformed in spite of noble intentions by some compassionate doctors. Also, if we are to make our expectations possible upon the doctors, we have to look at once in which type of environs doctors have been working at governmental hospitals. In the centre of our national health service, there are primary health centres, block primary health centres, and also sub-divisional and district hospitals. Besides, there are rural hospitals, maternity hospitals, leprosy or TB hospitals etc. But what’s the matter of great sorrow is that only the few govt. big metropolitan hospitals stay in the lime-light. As the journalists and TV channels crews reach there within a short while if and when any imbroglio is cropped up – so the govt. stays on the alert about any sort of administrative chaos in those hospitals. But, besides those selected metropolitan govt. hospitals, what is being happened in most of all other urban and rural hospitals across the nation no govt. functionaries have any least concern though common people having had similar suffering or experience in the past feel to the bones.
Senior doctors in the hospitals do not stay after far into the midday. When RMO will be available, nobody knows! RMO, who should attend the patient if and when necessary round the clock, now a days, does not stay in his adjacent hospital quarter. Number of free-beds is being curtailed, patients’ foodstuffs are being sold outside, supply of life-saving drugs is being curtailed or somewhere stopped, having started “private partnership”- non-governmental pathological diagnostic centres are being enthused stopping the use of hospitals’ own laboratories, also hundreds of thousands of govt. pathological and radiological clinics in the hospitals and health centres have been stopped. Govt. now don’t even want to keep the responsibility of treating of its servants through the govt. hospitals, tie-up has been done with the private nursing homes in this regard. Between whiles, announcement for medical seat increasement is made to divert the public outrage against the entire corrupt system. That is also done, my friends, keep it in mind, not to consolidate the govt.-sponsored medical systems but to supply doctors in the private health-care industry abhorrently.
Somewhere or else, in the govt. hospitals, patients are being died because of inattention, lack of medicines or without getting any other necessary apparatus. As a result, without accepting the woeful agonizing death, patient’s relatives are being about to hurt with aggressive and menacing appearance. Hospitals are being ransacked and vandalized. Doctors are being assaulted and are giving up duties indefinitely. Then, a few days later, they are rejoining duties being contented with some governmental promises. By this time, erudite intelligentsia are feeling the pricking of conscience and are rumbling in the news channels. My question is : does our govt. at all want to change the public health care infrastructure? Practically, methinks, our central governments didn’t draw up any such concrete policy or didn’t stride any such endeavour, so that common people can think that govt. has any genuine responsibility to the govt.-sponsored health care system. On the contrary, our governments have no shortfall in promptitude to give active assistance and patronization for the private medical systems. Because, government’s disposition has already been exposed, as it is now considering, not to care a farthing, he vast multitude of patients as customers to satisfy their profit-making motives.
Mind you the treatment of the patients does not mean only medical assistance; they expect compassion, co-operation and humanity from the doctors and their support stuffs. But, we all very well know, that is indigence in the govt. hospitals. Poor patients imperfectly educated or without the rudiments of knowledge, come to the unknown big cities for treatment from the rural outskirts. So big city, everything new and having seriously ill patient with them – they are reaching to the hospitals groping and getting nonplussed failing to ascertain the right way. They get confused where is the out-patient department, where card is to be registered from, where are the specialist doctors, where is hospital pharmacy, where is blood-bank, where scan has to be done from and so on. If asked twice most of the doctors give then rebuff, doctors don’t even want to make them know clearly what has happened to their patients. In time or out of time, one medical college, patients relatives get into the scrape, they can’t understand who should be approached for bed and admission. At length, they get into the clutches of cambists. So every big metropolitan hospital needs to have a help-desk for stopping their exasperation. Can’t some separate staffs be appointed to help them? Can’t the govt. take the assistance of some reputed NGO’s?
In the end, private system or public-private partnership cannot be the alternative concept for govt.-sponsored health care infrastructure. So, the governmental health policies need to be invested with concrete shape for facilitating the treatment of the vast concourse of Indian people. And our respectful doctors should practice human values and humanistic approaches in their personal life, as good-charactered virtuous patient-sympathetic doctors are microscopic minority now a days. If my doctor besides administering medicines keeps his benignant hand to the forehead of my disease-stricken body – I feel greatly relieved. We still consider doctors next to God. My dear doctors, we don’t want to see your social respect weltering on the ground. You only can show light of hope promising good.
