Health – Money And Connections

It was end of April 2021 and Covid 19 was ravaging through India. A doctor by the name of Dr Subrata Dutta was on the BBC Radio Today Show. Dr Dutta spoke with clarity, empathy and determination about the various challenges of his peers and his hopes on the vaccine.

However he truly grabbed my attention when he made a comment on the very delicate issue of` privilege of access to health care. As a head of medical association of India he had written to the PM of India asking him to put a pause to the, what he described, as the VIP culture. Young doctors were not only having to cope with the deluge of people struggling to breathe but also having to deal with phone calls from ministers and officials seeking favours to get accelerated access to already threadbare and now dwindling health care system.

Dr Dutta’s bold demands reminded me of a conversation I had with my friend after his wife had a surgical treatment in a hospital in UK – “We had no trouble getting the operation done even though we didn’t know anyone in the hospital. And it was all free.” Me and my husband had been long enough in the UK to expect this ease of access to health but we intuitively understood what he meant by “We didn’t know anybody in the system.” The fact that one could walk into a hospital and get excellent free care without having any personal references was definitely something to write home about because the idea that one has to have connections to be treated fairly by the medical system has been ingrained in us.

Dr Dutta’s comment lead me to reflect on my life experience in the Indian medical system and the issues of money, connections and trust.

My father worked for a Thermal power plant and I grew up in the residential Township adjacent to the power plant. There was a small hospital within the boundaries of the Township and all the employees and their families had access to it. The patients from the adjoining villages were not turned away. There were a few doctors and nurses and the equipment was good enough to manage small emergencies. We went there to get vaccinated or to treat a cut that warranted a stitch. In case of the measles or chicken pox the doctor would pay a visit home to confirm the suspicion and bestow a home quarantine. However our parents didn’t have much trust in these doctors, often referred to as” Township Doctors” and felt obliged to look beyond the amenities of this free hospital. Yes the “Township Doctor” would always be consulted but if your parents didn’t call in the big guns when your high fever shows no sign of abating after three days then the neighbourhood would be rumbling with allegations of parental stupidity and neglect. The “Township Doctors” had learnt to accept this inevitable arrangement so much so that if called in an emergency situation in the middle of the night they would politely enquire – “What did Dr paid and hence more dependable say?”

This magician who was called upon for these perceived serious cases was a doctor who ran a private clinic in a nearby town. It was a 45 minute rickshaw ride from the Township and the queues were long. But he had a telephone (a rare commodity) and one could book a home visit with him. He also had a car (another rarity) and would visit us in the afternoons. He would mostly confirm the treatment already prescribed by the Township Doctor. I felt better as soon as I heard him greet my parents at the door. His fees were not high but even then it was an expense we could ill afford but never did I hear my father complain about the value of the doctors visit. His voice was almost apologetic when he said “Doctor Babu your fees” as he hurriedly passed on a ten rupee note (the crispiest one that he had pre-selected in preparation of the visit) to him.

The doctor’s reputation was not untainted however – people complained of delayed visits (he bundled up visits to minimise fuel expenses they said), misdiagnosis and over prescription of drugs. Did he treat us better because his daughter knew me or because we showed greater trust in him. We will never know.

I had a serious eye condition and we had to travel to the big city of Kolkata to see a specialist. The nearby city must have had ophthalmologists but a respected and well connected relative in the family had recommended this elderly doctor and that was that. His fees were affordable and appointment easily available. Those appointments in the dull and dark treatment room with the frail doctor and his slow movements were one of the worst days of my life. But he knew someone in our family and that meant we trusted him to do his best.

And then was those really serious diseases which require hospitalisation and may be fatal. My grand father died of a heart attack after a short bout of seasonal flu. The family had no telephone, the daughters (my aunts) travelled a few good kilometres into town to fetch the doctor. He came as soon as he could but that was still too late. He refused a visiting fee. My grand father was not just his patient but his friend too.

My father’s mother had a less easy escape. She had cancer and was admitted to a government hospital. We didn’t have enough disposable cash to admit her to a private hospital but one of my father’s sister was married well. Her in laws had good connection which gave my father’s family a way into a reputed cancer specialist and, through him, to a government hospital. We didn’t dare to question what would have happened If that connection didn’t exist.

As a young adult I fell under the influence of a viral fever ahead of, what may be considered as the most important examination of a young Indian’s life – the pre University examination. My aunt, the one who married well, came to our rescue. She had befriended a very young but talented doctor. The doctor came to see me at home (only the best for the adopted niece) and clever as he was sussed it out at a glance. He asked my parents to leave the room and assured me that I was probably more prepared for my exams than I had estimated. I will be forever grateful to him for correctly diagnosing that my condition was more psychological than physical. Thanks to my aunt’s connections I was rescued from the possibility of a less able doctor.

Later as a engineering student I had a serious ailment and under the impression that I was dying. I saw a few doctors in Hyderabad but things didn’t improve. I came back to my parents with a body covered with large, juicy, yellow angry boils so much so that I could not even walk. My father’s brother said that one of his friends was a “dangerously good doctor”. My uncle arranged for an appointment and on the first one he diagnosed me with a metal allergy (nickel to be specific).

By the time I left Kolkata for other cities in India and eventually left the country the health system in Kolkata was undergoing tectonic shifts. The city was dotted with tall white shiny buildings hosting hospitals run by corporate houses – referred to as corporate hospitals. The roadside billboards were plastered with advertisements of the wares these providers sold along with the prices – Get your bypass surgery done for XX lakhs of rupees or your kidney stone removed for YY lakhs and so on.

A few years later I received a call form my mother saying my father was not well, he had been admitted to one of these corporate hospitals and would need a surgery. That surgery had to be cancelled at the last moment and I took a flight back to Kolkata. The level of incompetence and negligence leading to the cancellation of the surgery was rather distressing and we didn’t have the trust to go through the procedure in that institution. I got in touch with a very good friend of mine, she introduced me to a friend consultant, he made time for me, helped me to find a bed for my father in another corporate hospital and agreed to do the operation. We transferred my father there and my father made a good recovery. The day of the surgery (a very simple procedure) was long and anxious. In the evening mother and I lay in the dark listening to a phone-in radio show on the local Bengali station when a young girl called in to talk about her father who was ill from the same medical condition my father was recovering from. The girl’s father had suffered a painful death because the government hospital couldn’t attach a catheter. We processed the vivid description in rapt silence as she publicly ruminated the struggle her father went through in the final hours. Was it just a coincidence or our conscience telling us that one day it could be us. The financial distress my pensioner father would have been under if he had to himself pay for this operation was not lost on us. The crowd funding platforms are dotted with respectable educated middleclass families seeking out kindness of strangers to fund the treatment, and sometimes even palliative care, for their loved ones. We only beg because we have drained all their live savings in the process – they plea.

Towards the end of March 2021 news of scarcity of beds and O2 in India started to flow in through the news channels and the social media but there is one which aptly encapsulated the situation for me. The young man said ” I am shivering as I see influential people begging for beds on twitter. These people would have no problem getting a bed not just in ordinary times but in extra ordinary times too. This must be a catastrophe.”

Is our brave Dr Dutta merely telling the VIPs – Do not call and distract us because there is nothing to buy with your money or connections.

Would this levelling of scarcity lead to levelling of access in the future? We live in hope.