Health Systems

In Dubious Battle: Ramdev versus the Indian Medical Association Sanjay Nagral  25 Jun 202 https://www.theindiaforum.in/article/dubious-battle-ramdev-versus-indian-medical-association

The distinction between the low-key affordable medicines offered by neighbourhood traditional practitioners and the humungous business empire built by Ramdev that thrives on a combination of fantastic claims, powerful marketing and proximity to power is not easy to discern for well-wishers of traditional medicine. There is a method in Ramdev’s madness and going by the huge growth of his empire it has worked for him. He is also assured of state patronage with two senior cabinet ministers, including the health minister, attending the launch of so-called research on the 'wonder drug' Coronil, which claims highly effective protection against Covid-19.

The popularity of Ayurveda and other traditional systems of medicine is partly a result of their strong historical roots. They also appeal to people as an alternative to the excesses, costs and inaccessibility of modern medicine (often called ‘allopathy’, a term that was first popularised by Samuel Hanemann, the 18th century inventor of homeopathy).

There are a variety of practitioners in India owing allegiance to Ayurveda. There is the traditional healer who dispenses home remedies or low-cost herbal preparations based on hereditary knowledge. Then there are the large number of formally trained Ayurveda graduates. Many of them enrolled for an Ayurveda degree not necessarily out of a love for Ayurveda but as a second-best option to the MBBS degree, an option that still gives them upward mobility, social status and even value in the marriage market. Most of them end up practicing modern medicine.

The interests of the IMA leadership have changed over the years. This has paralleled the rise of private medicine and medical education in India. Many doctors in India are entrepreneurs and have direct investments in their clinical practice. The IMA leadership has been slowly transformed to reflect these interests. The strongest activity of the IMA in recent years has been its role in strengthening the narrative that the modern medical professionals’ interests are under threat and hence need to be defended .

The tussle between the rationalism of science and obscurantism is complex and nuanced. The terrain that matters is not TV studio debates, but early education and day to day activities. Science needs the inculcation of a faith in the scientific process amongst large sections of people, which is very different from obtaining science degrees or posturing. Currently even modern medical education and practice in India is hugely deficient on this front. In India, attempts to promote a rationalist mindset by taking on self-styled godmen and exposing fakery can even be dangerous as we saw in the murder of Dr Narendra Dabholkar.

The Covid Mortuary

We emptied our COVID ward two days ago.

Trusting the world’s incompetence at learning and planning, I am fully aware we will have to reopen it in some time. Still, an empty ward is a sight I never imagined could be this pacifying.

The Covid Ward in Shaheed Hospital, Dalli Rajhara, Chhattisgarh saw an overwhelming  number of stories with all possible outcomes during the last two and a half months. The stories are not different from what you saw on TV and  lived too  because I am sure someone from your family also struggled for breaths. Their scripts though, have more content than stories elsewhere.

The number of patients we lost in April-May exceeded twice of what we lose in an entire year. The number of people we had to turn away exceeded the numbers we treated.  What made it worse was knowing that the person I am denying admission was not going to get admission elsewhere too. The injustice that laughed at a patient dying inside the ward due to delayed admission and no vaccination, laughed harder at the patient who was turned away from the hospital’s gate.

There was less time to treat, even lesser to mourn and literally no time to let it all sink in.

In a short period of time, I have moved from being terrified to be numbed by the flow of patients in and out of the mortuary.
On one such night of numbness, standing outside the mortuary and gazing at the corpses through a narrow window, I happened to realize there were few additional chambers.

The lowermost chamber was for the corpse of Humanitarian Politics. She had died well before the pandemic set in but I saw her ready for the last rites for the first time. She  was all bones and no skin and it looked  like vultures have had their fun with her. She  had a heart which was cut open from the middle and eyes that were left untouched.

The chamber adjacent to it was for Global Solidarity. He  was kept suited up in Armani, for his last wish was  to look good at the outset even after death. A thousand pages of conspiracy theories kept bundled near his head, he had shoes brought from UN’s office. The suit covered the cracks he had in his skin, the shoes covered gangrenous feets. People whisper it was a suicide.

The chamber above had Scientific Temperament lying in a rugged coat. He lived a secret life in India, kept working silently and the moment he tried to come out, he was lynched to death. Witnesses say he screamed a lot. But no one came to help. Sad.

The chamber next to it had Social Solidarity. She  had clothes of all colors. All blood stained. She  was stabbed multiple times on news channels for days and ultimately died of shock. No method of resuscitation worked.

The smallest chamber in the corner had no corpse but a hefty bunch of papers. They were the political commitments of health. They were very neat and beautiful. I hope they get mummified and discovered later sometime in future.

Above that, was Privilege. He helped people reach faster than anyone else to the ERs, move to multiple ERs too. He did his best to cover political goof ups and inequities. But he died too, for he was very fragile in his making and  there is a limit to stealing someone else’s oxygen. To be honest I wasn’t much sad about this chamber.

One of the chambers at the top had Trust. He  gave a long fight. A tough fight. But succumbed to internal injuries. He tried to keep the doctors and patients together. He tried to make people believe that healing is a process of equal participation. But he suffered progressive ischaemia and gave up.

Besides these, there is a heap of corpses lying behind the mortuary. Difficult to identify, it has all the dreams of equities in healthcare lying dead. Poisoned, perhaps. Not sure whether they will find a space inside the mortuary or not. Will see in sometime.

Do these corpses let other ones lie peacefully even in a mortuary? This whole sight, will surely take some time to settle in my head and heart.  

In a rural-tribal area like ours, mortuaries do always have these extra chambers. Its just that they almost never make it to a national register. The moment a patient is received in the ER or OPD, his/her chances of survival become a function of all the factors that contributed to the death of above deceased entities. Every step of the treatment then, becomes a fight with injustice that has been done and being done to the patient. In a privileged urban setting where all the demigods of healthcare and politics visit so often, these fights find no space.

The struggle to provide quality care in difficult areas goes on in its traditional way, only this time the pandemic catalyzed the rate at which it consumes it participants.

This makes me mention another chamber in the mortuary. The topmost one. Its still empty. It is reserved for my Faith and few other silly things. My faith that all this, is meant for something better in future. My faith, that those who died were not all sinners and the people who lost someone have something good coming there way. That universe will compensate for this in some way. My belief that all the efforts, regardless of the outcomes will make society learn something.

A hope that this last chamber remains empty just like our Covid Ward.

Vidit Panchal

MP | Junior Doctors Submit Mass Resignation, Strike On .Jun 6, 2021   https://www.youtube.com/watch?v=Sykq_jLUYRY   In Madhya Pradesh's Indore, the junior doctors are adamant on their demands and the strike dragged on for four days due to no talks with the government so far. Madhya Pradesh Medical Officers Association also supported JDA's strike. Meanwhile, the High Court has declared this strike "illegal" and issued an order for the protesting doctors to return to work. Junior Doctors Association spokesperson Kirti Sinha said that more than 2000 junior doctors across the state and about 450 junior doctors from Indore met the Dean and submitted their resignations. The government only gives assurance but refuse to accept the demands, the protesting doctors said.

Since most consumers are at the mercy of the hospital once the patient is admitted in an emergency.. a responsible sovereign should take steps to see the justice and fair play is followed. Even now a CAG like audit should be imposed on the billing systems in all major private hospitals. This audit should be as per ISO standards where incoming biils are matched with outgoing bills, patient wise..   All Billing which exceed a certain acceptable limit , should be red flagged and subject to both medical and financial audit.

https://thewire.in/health/covid-19-crisis-delhi-oxygen-dhli-hospital Jun 11, 2021 | Kavaljit Singh

COVID-19 Killed My Wife. Then Came a 19 Lakh Bill From a Hospital That Didn't Have a CT Scanner.
Thousands of patients have received inflated bills across the country. Our personal tragedy underscores the need to rethink India’s privately owned healthcare industry and restrain rampant profiteering. 

Pandemic or not, protecting the health of citizens should be the priority of any government. The governments must ensure that citizens get affordable treatment and any unfair practices by private hospitals and other entities are curbed. Hence, our message to the Delhi government is clear: please exercise all powers at your disposal to curb undue profiteering practices carried out by private hospitals in the city.

After all, overcharging and other unfair practices by private hospitals are neither new nor accidental, but by design because of a combination of factors that include: weak regulatory framework, poor monitoring and enforcement of government orders, lack of transparency by private hospitals, and absence of a robust grievance redressal mechanism. With health being a state subject, the Delhi government is duty-bound to ensure responsible behaviour and accountability by private hospitals. 

the Delhi government must regularly monitor the implementation of its June 2020 order by making surprise visits to the private hospitals and checking their billing records to determine whether or not the price caps for COVID-19 treatment are being implemented in letter and spirit.