In 2005, I joined one of Mumbai’s largest suburban Municipal hospitals as a visiting surgeon. This institution treats a large number of accident victims on a daily basis and has treated a number of those injured in the riots and bomb blasts that swept Mumbai in the past few decades.
To my disbelief, I soon realised that our department’s capacity to treat these patients was being severely compromised by the absence of a CT scan machine in the hospital. I was also shocked to observe that patients were being sent to private centres nearby for a charge or to faraway public hospitals, resulting in huge delays in treatment.
My colleagues and I soon raised this matter through multiple letters and meetings with the administration, but to no avail. We were told that a demand for a CT scanner had been pending for years. Meanwhile, patients continued to suffer and I suspect many young lives were lost due to the delay in obtaining CT scans.
Finally, with what I imagined at that time as my ‘political’ insight, I decided to use a different approach. There was a local corporator who used to meet us to inquire about patients from her constituency and seemed concerned about the hospital’s services.
I suggested that she could take up the issue of the lack of a CT scan machine as a public campaign. I tried to convince her that this could help her win the elections to the Mumbai Municipal Corporation due that year. To her credit, she took up the issue, fought it out in the public health committee of the corporation and finally persuaded the authorites to procure a CT scanner.
On the day the machine was installed, she put up posters around the constituency, claiming victory in her fight for better healthcare for the citizens. We organised a small thanksgiving ceremony where I remember talking about how we could transform the hospital if healthcare becomes a local political issue.
The elections were soon held. She lost by a huge margin to a new candidate largely known as an organiser of the local Ganesh Festivals. When I bumped into her later, she, looking dejected, tried to explain:
People don’t necessarily vote on such issues. There are many other issues that overwhelm people when they press the button in the polling booth. I have learnt a lesson.
The dysfunctional and broken state of India’s healthcare system is there for everyone to see. All opinion, analysis and data over the years have repeated ad nauseum that across political parties, healthcare has been given low priority. As a result, India performs poorly in care delivery – our health indices are some of the worst in the word.
Healthcare as an electoral agenda
There is also consensus from the right to the left that without a well-funded and robust public health system, no country can provide decent healthcare to its citizens. The experience of some states in India and other countries is very clear on this. With so much consensus and evidence, what then is the missing link that prevents change?
We saw a substantive amount of scholarly analysis around healthcare during the build-up to this election. This was partly due to the Centre’s staging of Ayushmaan Bharat. In a piece I wrote a few months ago, I reflected on the experience of a public health insurance scheme similar to Ayushmaan Bharat as it had played out in the same public hospital.
I ended the piece on a note of cautious optimism, wondering whether with Narendra Modi pushing Ayushmaan Bharat as a game changer and Rahul Gandhi responding to it with an alternative policy for universal healthcare, we were finally seeing a serious focus on health-related policy in national politics. Following that, the Congress manifesto went a step further by proposing the idea of a Right to Healthcare Act, while the BJP promised more funding for healthcare. But alas, all this was a few weeks ago.
In the meanwhile much else was blowing in the wind. Healthcare soon had to compete with Pulwama, Balakot, Chowkidari, the NRC and dynastic politics. As far as eyeballs and emotions are concerned, a powerful and unequal competition had emerged.
What the local corporator had realised after her experience, our astute political class had, perhaps, understood long ago. There are easier and quicker pathways to electoral success.
Middle class and political apathy towards healthcare
As we enter the last lap of the electoral race and await the results, I almost have a sense of déjà vu. Notwithstanding the results, what role did issues like healthcare and education finally play? And if they didn’t, will anything change at all?
Do we need to dig deeper and raise uncomfortable questions rather than just lament over the state of healthcare through op-ed pieces? Is there something more at work here? For example, is it the fact that the elite, which includes many of us, have resolved their own healthcare issues through the creation of a private sector and while we all pay lip service to it, we are no longer invested in change?
In other words, as Taleb puts it, is it that those who can change health policy no longer have “skin in the game” of public health? Shall we also question why our ordinary citizens do not force these issues to the forefront during election time and hold candidates accountable? Is there something about our cultural capacity that internalises death and disease as our fate and destiny? Are other daily challenges too overwhelming for us to notice the inequity in healthcare?
Or is it that having been chronically exposed to a certain system that passes for healthcare, ordinary people cannot even fathom an alternative? How will they know that there is an alternative that currently works in many countries which guarantees immediate, decent care that is worth fighting for?
I am aware that, in many states of India, ordinary people have indeed fought remarkable struggles for health rights. There is also a growing national movement comprising largely of the middle class against, what is nothing but, the predictable excesses of an explosion of market medicine.
Maybe these movements will converge and see through the structural discrimination within the healthcare system which has created ‘state of the art’ hospitals where one can get a CT scan within minutes at an astronomical cost while large public hospitals exist without CT scans for the grievously injured. For someone like me, who has witnessed the havoc that illnesses cause on a daily basis, I cannot but be cautiously optimistic about the future.
As for our hospital, the CT scan unit is currently facing a lack of staffing. Many patients still have to be shifted for emergency CT scans. Once again, we made an effort to highlight the issue, this time, by approaching corporators across political parties. We were largely ignored. One of them even told us curtly, “Doctor you don’t understand politics; we are in an electoral battle, this is not the best time to raise such issues.”