Public health: How to make a difference

“If it were possible to evaluate the loss, which this country annually suffers through the avoidable waste of valuable human material and the lowering of human efficiency through malnutrition and preventable morbidity…we feel that the result would be so startling that the whole country would be aroused and would not rest until a radical change had been brought about.”

The above comment is from Joseph Bhore, the British officer who in 1946 headed the committee which drafted the guidelines for a healthcare system in India. The committee proposed socialised healthcare based on which the Nehru government brought some of the finest medical minds to the fore. Dr Sushila Nayyar, Dr B C Roy, Dr Shanta, Dr Krishnamurthy and Dr Muthulaxmi Reddy are some of the stalwarts who laid the foundations for universal healthcare. 

Primary health centres, block, district and state-level government hospitals, and the training of nursing and paramedical staff were established. Many serious, communicable diseases were eradicated or controlled, immunisation programmes initiated, the scope of antenatal care, infant care and nutritional support to the poor expanded.

Track DH's Independence Day Coverage Here

Other welfare measures like having a crèche/anganwadi near the workplace, mid-day meals at government schools, subsidised rations for the poor and the training of village health workers happened in later years.

This well-intentioned system gradually deteriorated due to political apathy, corruption and greed. Young doctors moved westward – to the UK and the US mostly and highly skilled doctors in India started setting up private centres. 

Within a decade, the corporate sector stepped in with high-end medical care. The government encouraged privatisation while reducing the money spent on the original socialised system. And sadly, it never bothered to address unethical practices that became rampant.

We cannot blame the public for perceiving healthcare as a money-making racket. Seven per cent Indians (63 million) are said to fall below the poverty line every year due to health care expenditure.

Uneven healthcare which favours privileged classes is detrimental to the future of a nation. We are well behind most countries in all human developmental indices which concern health. And yet, our ‘political heroes’ repeatedly proclaim that they have got everything right. High decibel pronouncements and hastily planned flagship programmes are of value only when they reach the underprivileged millions.

Is there any cause at all for cheer? Yes, there is.

Many among the 50,000 doctors graduating every year take up specialisation and are absorbed by corporate hospitals. A smaller number among them, mould their careers around the anxieties and cares of society. They go where there is a dire need and bring about dramatic and positive changes. It is time we looked at what they have achieved.

In 1996 a group of young doctors completing their postgraduate studies in AIIMS, New Delhi decided to work in a backward area of Chattisgarh. Dr Raman and Dr Anju Kataria, Dr Yogesh and Dr Rachna Jain founded the Jan Swasthya Sahyog in Ganyari. Much of their village outreach programmes are conducted in tandem with state-run health departments and supported by visionary institutions like MGIMS Wardha, St John’s Medical College Bengaluru and CMC, Vellore. They provide high-quality, low-cost care to thousands of people, train health workers, and undertake medical research. Their phenomenal work is supported by the Tata Trusts.

Rishi Valley, in Madanapalle district of Andhra Pradesh, is well known for the school founded on the ideals of philosopher J Krishnamurti. Barely a kilometre from the school is the Rishi Valley Rural Health Centre run by Dr Karthik Kalyanram, his wife Dr Vidya, and Dr Ramesh. Their modest hospital is thronged by patients. The quiet discipline of waiting crowds is startling. Perhaps they are content in the knowledge that they are in trustworthy hands. Besides patient care, they have a research centre which works on the treatment of tuberculosis, headed by Dr Vidya, a pathologist.

How many of us know that leprosy is still very prevalent in India? Dr Auburn Jacob decided to devote his life to the treatment of leprosy patients. After several years of intensive training in leprosy care and surgery, he set up work at Palamaner, Andhra Pradesh, where the disease is rampant. Anyone who has visited the centre will vouch for its very high standards of care and the rehabilitation of healed patients. Now in his seventies, Dr Jacob still works and trains young doctors in this field.

Dr Ravi Kannan is a surgeon trained in cancer surgery. Twelve years ago he went to the northeast to set up the Cachar Cancer hospital in the remote and rugged terrain of Silchar district, Meghalaya. Hundreds of cancer patients are rescued yearly from painful suffering by Dr Kannan and his team.

We have, in India, a 1,000-member strong Association of Rural Surgeons of India (ARSI) who meet at regular conferences and spread awareness about the need for skilled surgeons in rural areas. There are mission hospitals of different religious denominations which cater to the average citizen and do much to help the poor. 

There are hundreds of catholic nuns and some swamis who become doctors and thereafter do dedicated work, retiring only in their late seventies. I know one nun past eighty who treats patients every day.

In Bengaluru, there is SOCHARA, founded by Dr Ravi and Dr Thelma Narayan, an institution that trains community health professionals. SOCHARA has constantly highlighted the defects in our system and influenced major health policies in the country. It has helped hundreds of doctors make wise career choices which ultimately make a vast difference in how doctors decide to utilise their skills.

There are many more doctors who battle great obstacles to reach the unreached. Their work sparkles with energy and hope; they build sustainable institutions that will stand the test of time. These then are the shrines, the temples, to which I offer my humble salutations.

I fervently hope that our skilled young doctors will be inspired by visiting such hallowed centres and be infused with need-based ambition. I hope the government will see the value of their work and revive socialised healthcare countrywide.

Do we wish to make or break the health of our nation? The choice is ours.

(Kavery Nambisan is a surgeon and novelist. A Luxury Called Health is her recently published medical memoir.)