State of our Health Care: Infrastructure or Culture

In these times, when there is Oxygen Crisis in India, I choose to direct my attention on “Care” because it predates and precedes the ongoing happenings and is also a cause of the present crisis.

This is very plain in India that if one member of the house is hospitalized, every member of the house are hospitalized too. The other members need not occupy the bed, they occupy the adjoining sofa, or the floor. It’s become a tradition in India that attending to sick person is the job of the family member. The hospital attendants, nurses, who are supposed to take care, do not show any inclination to do so and their apathetic behavior are something every hospital borne person has to contend with.

If the patient is asleep and the family or the relative is elsewhere, the hospital attendant who arrives with snacks or food, will just drop it on a table nearby, not even bothering to wake the patient or even roll the table so that the food is near at hand for the sick to eat.

The same applies to nurses who are supposed to administer medicine. The nurse, if they show some little concern, just punch out the required dose of tablets and capsules and drop in a tray. It’s the patient’s family who then gets the patients up to feed the medicine. Or mostly, this happens. The nurse enters and says – take this and this and this – and thereafter are in a hurry to scurry out. If the relative of the patient is old or unable to grasp the instructions properly and asks to repeat the instructions; just notice the facial expression of exasperation and hardness in their voice.

Okay, we understand that hospital environment is stressful and the people working there are “doing a great job” and we have all beaten our own share of utensils, but, – it’s their job – isn’t it. If the Health Care workers don’t like the job and can’ take the stress, they should quit and search for another compatible occupation. But the health care workers do not become “great and vital” just by the virtue of their position and sans the service required.

I’ve seen these abject state of affairs in good hospitals and even in a good class of that hospital accommodation.

My sister was hospitalized in 2018 for Dengue in Kokilaben. It was a decent two bed accommodation. But the service was far short of expected. Being weak with dengue, my sister had not enough strength to reach for the table on which snacks or food used to be dropped. Me, who is a bit of a roving kind, chose to wander the hospital and in a starbucks cafe on the ground floor. Innumerable times, the tea or snacks or food grew cold on the table and no one alerted my bedridden sister. Yes, she should have called the nurse. But when the patient is sick, firstly they don’t have much desire to eat. Also, just like a “tradition in Indian Hospitals,” the patient thinks it’s best to call the relative where food and other attendance are concerned.

Now lets see this “tradition in Indian Hospital” in the light of a new kind of malady, which basically changed the way patients are looked after. Before covid, the relatives were there for administering medicine, food and help to go to the toilet. After covid, no nobody is there to attend the patient. No One.

One cannot change culture overnight. “New Culture” cannot start on 24th March 2020, with “Lock-down.” So, you see, India is dealing with this new crisis with old methods and mindset.

I will tell you how. I was afflicted with covid last year June 2020. Here is a link of my experiences. I was admitted in Holy Family for 10 days isolation. I’m attaching my hospital bills just to give you an idea of what it could be for anyone facing similarly.

The bill has many interesting facts.

Each time the doctor showed up there was a charge. Well, that’s fair. But each time the doctor showed up, he/she wore PPE (personal protective equipments) and the hospital charged me for every equipment they wore. PPE and the Masks were charged separately.

The most all the doctors visits did was; they stood at a distance from me, near the door and sent forth one of their junior doctors or the nurse with oximeter. That’s all. They are wearing attire for which I had paid and not even venture close to me.

With no family member with me, in quarantine, I stayed alone. My snacks and food were dumped periodically on a table on the far side of the bed. No one woke me ever, or even offered to roll the table upto my bed. They entered, dumped, and out. And this is happening to someone who is paying Rs. 5000 per day for the room plus also what they are wearing.

Now, I take my scenario and regress downwards. Consider a situation when people, not affording the expenditure which I had shelled, also encounter the similar situation. I was healthy, mobile and for me, staying alone, isolated is not a problem at all. But think of those, who are old, invalid or handicapped due to covid, has to stay alone, and with hospital services all around tuned to total apathy. It does not surprise me at all, when there are news which says, “Patient disappeared from ICU, Hospital says he died 15 days back.” Covid-19 apathy is another subject on its own. We only read what’s little that’s reported. There may be vast numbers existing out there in desperate and dire states.

Even if our infrastructure is weak and the logistics broken, if this – “care” – is in the “culture” of our people – two things will happen.

1) The Hospitals and Health care establishments, which is, in India, is a multi-billion dollar enterprise, will be proactive to provide the inmates with a quality of care suitable for convalescence. If nurses and other attendants have care in their hearts, they will pressure the higher ups and demand the tools that will help them to provide service.

Instead what is happening now. “Social Media-Fication,” show-offs, crocodile tears of the modern age. These are happening. The hospital care staffs are armed with pics and twitter updates to all helter-skelter, to show, as evidence, when asked – what have you done? They all say – Look, this is what I’m doing, updating every moment our state of affairs, tweeting for Oxygen, and posting on Facebook, to demand the wherewithal.

Besides, and these may not be even reported – the hospital attendants, in times of covid care, are busy to be as far from the affected patients as possible. I saw this myself when in hospital.

2) The life and lifestyle of the people of India, of the lower rungs, not particularly poor but not well to do either, is the cause of much distress in hospital care. You might wonder how? Let me explain.

The majority of Indian population live is small houses and pretty beat down living. They live like 10 in one room, and two, or even three, in one bed. No ventilation and of-course with poor hygiene. If one keeps this context in picture, imagine, a patient going to the hospital and asking for better care. It is not surprising that in states like UP and Bihar, there are two or three people on a bed. Well, they sleep at home like that, why should they demand any better in the hospital.

Now, covid comes – tell me who will provide social distance to people, who never experienced any social distance in their lives. Why would a hospital provide hygiene to people who never aspired for hygiene ever in there lives. For people of our class, if we see a dirty toilet, we may stop shitting for a week. Why would a hospital clean their toilet for people who never aspired for a clean toilet.

Incidentally, I’ve also had experience with subsidized hospitals too. My father who is a great believer in “simple living and high thinking,” (another name for poor taste) got admitted to Navneet Hi-tech Hospital near Dahisar in 2019 for Hernia Operation. While attending to him, I realised, he must of chosen the lowest of the low grade of bed, despite having a good insurance plan. For a week, I was living with people who were virtually from SRA (Slum Rehabilitation Authority.) There were two beds side-by-side in that pigeon hole, with barely two metal stools to sit on, one for me and the other for the attendant of the next bed, who never stopped looking at me for all the four days I was there.

There, in that hovel of a Hospital ward, I came face to face with “real India.” My many philosophies changed. In those four days I knew the true nature of man, the rudeness, the abjectness, the total non-care of the doctors and nurses and attendants, contemptible and degrading.

The investment in Hospital care, and with this covid type of disease which will be a new norm from now on, our hospital care has to change. There should be investment in such endeavors where people in hospital care jobs should go through re-education and sensitization on the quality of help that has a proper standard. We take “Care” as a given, as voluntary act of human being. No, it is not. The “Care” should not call for “Emotion.” “Care” should call for “Duty.” The carer “choose” to be “moved” when “camera shines” or taking “pictures” for Social Media, crying for 5 minutes of fame. This Ad-Hoc behaviour should be outright rejected or trolled and laughed “out of social media.”

Medical and Health care has never been a priority for any government and will never will be. Ayushman Bharat and other types of Health Insurances are just legislative. They provide the people with some mitigation but again, health insurance is a milking cow for the hospitals. But, let’s consider that people of India are “paying now or every year” for “Milk” to avail future “Hospital care,” either via tax or premium, aren’t people of India entitled for comensumerate Hospital Care. Should it not be an agenda for IRDAI (Insurance Regulatory and Development Authority) to for their attention to legislate the requirement for “Proper Care” so that, anyone, or bachelors like me, can get admitted to any hospital, stay alone, be attended to, get assisted, and not just disappear from the bed or die in the toilet and be discovered after 14 days.