I was eight years old when my grandmother and I were walking down the street to my native village in Punjab. A middle-aged man with slightly grey hair was coming towards us on his bicycle. My grandmother immediately pulled me to one side of the road and held my hands in a namaskar towards him.
As I had never seen him before, I didn’t realise why my grandmother did this. In fact, I was so curious that I asked her. She smiled at me and said that he was the only doctor in our village. “Education is the eternal power, and if you greet a literate person, then you will become like him one day,” she told me. That was the day when I decided to become a doctor. After completing high school, I pursued an MBBS course where I understood the ‘attachment’ of pain and emotions with the human body. While studying hard, I was also trying to find out the purpose of this profession.
When I was an intern and was posted in the emergency ward, a serious case once came to us. At that moment, I was the only doctor present. The patient was a 40-year-old man, accompanied by his wife and two children. As he was having a heart attack, I immediately started the resuscitation process after sounding the alarm to my seniors. Against the background of the family screaming, we worked really hard.
At around 4 AM, he was out of danger and I conveyed the message to his family. His wife and children were silent with extreme happiness showing on their faces. They held my hands together to thank me but they didn’t have words. At that time, I realized two things. First, it was the fact that even after thousands of years of communication, we still hadn’t developed a language or vocabulary which could express all our emotions. The second realisation was that even if you didn’t earn money, you could work for this expression for your entire life. It is the selfless nature of this service and the society’s respect which has made this profession pious.
Recently, a marquee at the Durga Puja at Mohammad Ali Park in Kolkata showcased a demon in the garb of a doctor. This is really disheartening for a person who has spent his life trying to become a doctor. It makes me think about where we went wrong. So, I came up with a few probable reasons which might explain the change in the public’s perception.
The first and foremost demand of public is to make healthcare affordable. The Arjun Sengupta Committee Report released in April 2009 revealed that, despite many years of economic growth, 77% of India’s population continued to live on less than $2 per day. As much as 86% of India’s workforce worked in the unorganized sector.
These people emerged as a sort of a coalition of socially-discriminated, educationally-deprived and economically- destitute citizens. On the other hand, less than one-fourth of India’s population continues to enjoy the fruits of high economic growth. So, it is well possible that for this large majority of India’s population who can’t afford costly healthcare, healthcare professionals seem to be demons.
According to the National Family Health Survey-3, the private medical sector remains the primary source of healthcare for 70% of the urban and 63% of the rural population. Out of a total of 4.7% of GDP expenditure in the health, only 1.4 % comes from public sector. It is unfortunate that private sector with their high charges for treatment is more accessible to people than the public sector.
It is no surprise when we see 69 million people pushed below the poverty line every year because of their out-of-pocket expenditure. A single person’s ailment can mean poverty for the entire family. And when the public suffers a lot – physically, mentally, financially, emotionally – they seek a way for an outburst. Unfortunately, doctors have become the face of government incompetence.
According to the Bhore Committee’s recommendations, India’s health system is divided into three tiers – primary, secondary and tertiary. In this tier system, it is expected that most of the healthcare-related work like prevention, treatment, and rehabilitation will be done at the primary and secondary level. Tertiary care centres with medical colleges are meant for the production of the best-quality doctors and for new research and innovation in healthcare.
Since most of India’s people are poor and live in villages, it was recommended that healthcare should be made accessible. It was also stated that it would be better to provide the best-quality healthcare at the doorsteps of these people, since they neither afford costly healthcare nor bear the costs of travelling to distant hospitals.
But today, after 70 years of ‘recommendations’, tertiary care centers are only involved in treatment. For instance, AIIMS, New Delhi, has a footfall of more than 10,000 in its outpatient department (OPD) per day. Basic facilities for both primary and secondary care are so ignored that they even don’t have ambulances to transport patients to tertiary care centers.
Today, we feel proud that we have connected Delhi to San Francisco or New York. But is it of any importance when our primary health centres (PHCs) are not connected to community health centres (CHCs) or district hospitals?
The study, “Health Workforce In India”, published in June 2016 claimed that only 18.8 % of doctors in rural India have the requisite medical qualification. This means that the rest are essentially practising quackery. These supposed ‘quacks’ are performing surgeries, giving chemo-therapies and also treating other diseases. They are playing with the lives of the public which has resulted in the loss of faith in the profession. The government is also taking no firm step to stop quackery in India.
I think the government should listen to the demands of the public and make up their mind to ensure ‘health for all’. Regulating the expansion of the private sector so as to be affordable to the masses, strengthening primary and secondary care centers, and the control and punishment of quackery can definitely help doctors regain their lost glory.