:: Kishwar Desai

A healthy debate

Kishwar Desai

Augest.29 : Life in India has always been cheap — and nothing drives the point home more than the state of our healthcare system, even in the capital. There is simply not enough to go around — and the recent, terrifying photograph of a woman, Sahina, sitting with her almost-brain dead son Mujahid on the pavement outside the All-India Institute of Medical Sciences (AIIMS) trauma hospital, hoping for help, proved it. The situation called for personal intervention from the health minister, but unless it’s a global scare like the swine flu, which gets him headlines, why would he bother? His insouciance is enough to give anyone nightmares.

The poor mother did not have money for her child’s treatment and so was allegedly turned away. This is a country that boasts of "medical tourism" and where there has been a recent Rs 1,000 crores takeover by Fortis of a whole hospital chain. None of this, however, will automatically lead to universal medical treatment. The ongoing debate in the United States over universal healthcare is something we should seriously conduct in India, as well. After all, if public money can be spent on building statues — the latest is Rs 350 crores by the Nationalist Congress Party-Congress combine on a Shivaji statue in Mumbai — there should be money available for free, universal healthcare.

However, this is not an easy issue to confront, as especially in a country like India, the sheer number of hospitals and doctors required is daunting. Also, as in the US, the medical insurance companies have a huge stake in subverting the debate, as do the large number of private practitioners and hospitals who would be very unhappy with the growth of free government medical help.

As someone who has been a beneficiary (albeit by proxy) of the National Health Service (NHS) in the UK, I find both the current level of animosity towards it in the US, and the complete apathy towards it in India, totally inexplicable. Actually, it is one service which deserves to be emulated.

In London, we have a large NHS hospital almost across the road from where we live — and the few times I have been there (usually accompanying someone) I have never encountered any rudeness or refusal. Frankly, I would never even dream of going to a private hospital in the UK. In India, it’s quite the reverse. Even though we live close to AIIMS in Delhi — and the doctors are reputed to be excellent — the fear of being rudely treated and memories of dirty corridors and waiting rooms keep me away.

Besides, in India, we, the middle class, only go to a hospital where we "know" the doctor personally, or if someone has been able to introduce the doctor to us. But how does 99 per cent of the country — without access to prompt healthcare information or personal phone numbers of doctors — manage?

Is it ever going to be possible to introduce an NHS in our country? It is desperately needed and required — and its sheer efficient anonymity is a huge relief. You don’t have to know anyone, you don’t even have to be a VIP — you can just walk in and you will be looked after. Even when my mother, as a visitor to the UK, accidentally fractured her wrist, they gave her immediate attention, though, of course, she had to queue up like everyone else.

Naturally, as a free service, the NHS is also the recipient of a lot of criticism. Yet, for a country with a rapidly aging population, it is specially good for the elderly, given the fact that most medical treatment is costly. For them, there is enormous comfort in knowing that once your doctor has filled in your prescription, you can pick up your medication (no matter how expensive) from any chemist in the UK, completely free of cost. It is a similar case when people have long-drawn out treatments, requiring hospital stay.

In India I’ve heard horror stories of people being turned out of hospitals because the expense became unmanageable. But under the NHS, if the illness requires it, a longer stay is possible with complete medical supervision. Both the current Prime Minister Gordon Brown and the Leader of the Opposition, David Cameron, have acknowledged their personal debt to the service. Mr Brown because he had a football accident in school and almost lost his eyesight; Mr Cameron because he had a mentally-challenged child, and needed the NHS day and night.

Despite all the positive NHS stories, US President Barack Obama is facing an uphill task both in Congress and outside in proposing a similar system. Unsurprisingly, TV channels in the US are flooded with advertisements advocating free choice. These commercials are largely based on unfortunate experiences with government-run services, including those in other countries — and the most common example is of the NHS. There has even been one completely nonsensical claim that Stephen Hawking would have not survived had he been a beneficiary of the health service.

For the US, which still remains an inequitable country, a good health service would at least assure those 30 per cent who are marginalised, and others who are struggling for a foothold, that their one basic need is looked after. On the other hand, there is also legitimate concern that the government is not always the best at running anything efficiently — and certainly in India we have enough examples of official bungling and corruption in almost every sector. Yet, what choice do we have in India where more than 90 per cent would need access to free care?

There is also enough evidence to show that the private sector on its own will not be able to provide the same facilities for those who cannot pay for them — and the reality is that millions of Indians who are unable to afford a decent meal are unlikely to receive medical assistance of any kind. Even those who are covered by government insurance schemes find themselves poorly treated.

In the US, whilst Mr Obama may not be able to replicate the NHS, at least he has started the process of thinking seriously about an alternative healthcare system. In India, urgent systemic overhaul is required. Unless we begin the debate now it will take another generation of healthcare deprivation before any government action is taken.

Kishwar Desai’s novel Witness the Night, to be published in January 2010, is on the longlist for the Man Asian Literary Prize, 2009. She can be contacted at

kishwardesai@yahoo.com