In her death was a question pondering on the stark reality of glorified India, answer to which lies in questioning the dichotomies of development and the erosion of the public interest.
Lying like a feeble soul on the blood smattered floor of a public hospital in urban Kolkatta, dear Pishi was striving for life at an age, which still remains a mystery, but she believed she was at least 65 or may be 70! Hailing from a rural part of Bengal now probably a part of the neighbouring country of Bangladesh she had seen it all, the independence, which never freed her from bondage, the wars that never eased her daily struggle. From the quaint distant village she travelled years ago to Delhi to evade the extreme lashes of poverty and betrayal that she had witnessed in her lifetime.
Far away from her home she found happiness in kids who she never biologically produced but on whom she showered love in abundance and with utmost honesty. For many Pishi was just a domestic help, but for us she epitomized the thread that binds the family with love and care. For years she was the one who held the strings of the family tight as my parents strived hard to balance their work and life. It was only the sudden revelation of her cancer that left the family shaken and almost orphaned. Though, we did not leave any stone unturned to get her the best medical services available, her final choice was to die in peace than suffer the apathy of the crumbling State run Medicare facilities.
I chose to write about it not as an obituary but probably as a concerned citizen who remains unnerved by the realities of the largest democracy and the overdependence on private sector for providing ‘noble’ health care facilities at the cost of exploiting the vulnerable.
To set the context- Below is a snippet from the letter that I wrote to the CM of West Bengal with no hope of an answer and as expected there was no answer – but nonetheless it was important to speak.
I happened to visit RG KAR recently to continue the line of treatment of Pishi who had been fighting with ‘periampullary carcinoma’ in lay terms ‘pancreatic cancer.’ Her first phase of treatment was successfully completed at AIIMS and I must credit the team of doctors who at every step cooperated, empathized and dedicatedly made an attempt to treat the patient despite various challenges and hurdles. Probably because of the ‘reference’ that worked but nonetheless the credit is theirs.
Sadly, due to circumstantial pressure we had to choose to continue the line of treatment in Kolkata (her hometown) for the last leg of the treatment. Due to proximity reasons her family showed faith in RG KAR medical college and from family and well-wishers in Kolkata we confirmed its credibility. I only wish I could vouch for the same as what I saw in RG KAR was not just poor infrastructural issue but inhuman conditions in which the patients are being treated.
What I witnessed around me was not just an awful reality of a broken health system but also negligence of the state in setting up accountability mechanisms. With one forced to carry bleeding and bruised patient in arms due to paucity of stretchers I saw people fighting for one single stretcher that they could trace after almost completing a round of treasure hunt. It would have been comical if it were not happening to one of us. Infrastructural provisions, which are as minor as availability of stretchers cannot be attributed to paucity of funds, rather sheer lack of effective managerial procedures.
Visuals that I saw inside the hospital still haunt me.
- Given the paucity of beds patients are forced to lie on the floor with just a plastic rug as their bed. To me it appeared as if everyone making an attempt to walk on that floor is trying his or her hand at football (Bengal’s favorite game). Only difference instead of a ball they kick needles, blood stained cotton swabs, empty bottles of medicine and at times the patients lying on the floor.
- With zero sanitation level, I wonder how the doctors manage to evade diseases forget about the condition of the patient who surely gets a lived experience of hell even before succumbing to their disease!
- I am not even getting on to describing the condition of the toilets, which probably are beyond description.
This whole incident left me besieged with thoughts on the bewildering state of health system that is moving beyond the realms of affordable and inclusive.
1. What happens when ‘publicness’ of public service degrades?
With the vocal middle class retracting from using the public health service, the accountability of public service has further declined which has gradually led to an erosion of the public trust. For a country where health policies are failing to benefit the poor and are in sync with the private players the impact on the social impetus is appalling. As government fails to deliver the public good an over bearing dependence on the private sector increases. In the context of health this means that the lack of trust on public hospitals pushes the powerful and questioning middle and upper middle class to seek services from the private sector, thereby leaving the poor and marginalized to be the major support seekers at the public hospitals. This has a severe impact on the accountability of the public institutes.
2. Is negative co-relation between unskilled migration and access to health services for below pyramid migrants a policy flaw?
In 2001, the Census reported 309 million internal migrants. Of these migrants,
70.7 per cent were women. Most of the internal migrants are unskilled and poor who are on the other end of the spectrum in the value chain based Medicare facilities. While there has been a pressing need to responsive policies that see right to health care from a human rights perspective the healthcare landscape in India has witnessed a paramount shift towards privatization. The decay of the public health care has in turn paved way for the privates to grow and despite being mandated to provide inclusive health care services the exclusiveness of the private hospitals is an unhidden reality. The Delhi Court has mandated free treatment for Economically Weaker Section (EWS) in the Delhi NCR region but there are many reports of hospitals violating the obligation. In absence of implementation of such provisions and abysmal state of public healthcare accessibility of quality medical facility seems a distant dream for people without deep pockets.
3. Are we forgetting being human and the reality of mortality?
The word ‘cancer’ had infused a sense of panic and every time I spoke to the team of doctors who provided the first leg of treatment, a sense of hope overtook the reality waiting in the shadows, as I knew Pishi would soon pass to light. To let her die with grace was a tough choice. The mirage of the palliative Medicare facilities was enwrapping as a soft delusional blanket comforting the reality of death. The day I saw her lying on the gory floors of the public hospital in Kolkata the glory of the medical science failed to romanticise the idea of life and longevity any further. Shedding the arrogance of medical miracles and accepting the traditional realities of life is truly a challenge posed by the modernity of technology. While I have seen a few in my family and friends succumb to cancer behind the shiny doors of the ICU, the lack of affordability had pitched a paradox within which I found the stippled reality of life.