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Oct-Dec2002-10(4)
LETTER FROM CHENNAI
Poverty and
excess
Thomas
George
A friend of mine recently joined a corporate
hospital as a junior consultant. One of his jobs, he found, was to go along with
other junior consultants and the marketing manager of the hospital to visit
general practitioners. The doctors would speak about the facilities available at
the hospital and request the GP to refer patients. The marketing manager would
then talk about the 'relationship' that could be built between the hospital and
the GP. Bluntly put, the GP was being offered a kickback to send patients. It
appears, therefore, that private hospitals are short of patients and are chasing
them through fair means and foul. Around the same time as my friend's
conversation, the newspapers reported attacks on doctors by relatives of
patients at two medical college hospitals in Tamil Nadu. In both cases the
relatives felt that negligence by the doctors and other hospital staff had led
to the death of the patients. There is no doubt that public hospitals are in
very bad shape. The buildings are usually in poor repair. The equipment has not
kept pace with needs and is often under repair. The hospitals are grossly
understaffed, so that no effective nursing can take place. Morale is poor
especially among the lower grade staff. Petty corruption is rampant. 'Fees' are
collected for every little thing. Without a full-time attendant in tow, patients
cannot get anything done. Yet these hospitals are crowded, with patients
occupying every available space. The crowds in spite of such poor services point
to a stark fact - these patients simply cannot afford to go anywhere
else.
If such a paradox exists - on the one hand
hospitals hunting for patients and on the other patients unable to access even
the minimum of care - society would be expected to take corrective steps. But
such is the level of our collective apathy that such gross disparities and the
evils that they engender are not even subjects of debate. But it is not
civilised to live in a society in which so many of our fellow citizens are so
deprived. And we must remember that there is a breaking point at which violent
upheaval will appear more attractive than the status quo. Attempts to divert the
public from the true cause of existing misery, to this or that imaginary enemy,
will work only for so long.
Several months after the tragedy in Erawadi, when
many mentally ill patients were burnt to death, unable to get away from an
accidental fire because they had been chained up in so-called private care
homes, the homes have slowly reappeared. This should be no surprise, because
caring for these patients in India often falls on the family and they are unable
to cope. Well-run private care facilities are very expensive. In government
institutions these people are poorly cared for. The only option for the
economically weak are these "homes". The fire and the deaths were just a
punctuation mark in the daily misery of these people.
The news of the arrest of a middleman who was arranging live unrelated donors for kidney transplants only confirms what many long suspected - that the racket was still thriving in Tamil Nadu. The authorisation committee was set up in a hasty way with government officials being appointed by virtue of their position - in officialese 'ex-officio'. All the donors were able to convince the committee that they were donating their kidneys to people not related to them, out of love. Surely it is necessary to have others too on the committee, and they should be carefully chosen so that the spirit of the law is adhered to.
Films and film people have always had a major role to play in the social life of Tamil Nadu. Yet the news that a fan of Rajnikanth's had his child delivered by Caesarean section two months prematurely to coincide with the release of the film Baba, is surely worrying. How was the man able to convince a doctor to do such an operation which is definitely not in the interests of child or mother, and therefore unethical? As for the Medical Council of Tamil Nadu, so far only a resounding silence.
Dr Thomas George, 114J, Rostrevor Garden, Chennai 600018. Email:gezarore@hotmail.com.