‘He (Mukul Sangma) told them (doctors) to have a heart for the poor and to stop prescribing branded drugs pushed by multinational drugs companies’

A recent article in a business newspaper caught my attention. A lady doctor in Thoothukudi, Tamil Nadu, was lynched following the death of a woman patient because of negligence.

After this incident, doctors in Tamil Nadu and those affiliated to the Indian Medical Association (IMA) all over the country went on a strike to demand full protection “in the discharge of their duties.”

This news went almost unnoticed in the northeastern states. But we are familiar with the casual and condescending manner with which most doctors treat patients. We are also familiar with how relatives react thereafter. In Assam Medical College, Dibrugarh, last year, a patient’s relatives got physical with doctors for not doing their duties according to the Hippocratic oath.

The history of healthcare in all the northeastern states is replete with medical negligence, especially in government-run hospitals. The farther away from the state capital you go, the more pathetic is the healthcare scenario.

In Assam, health minister Himanta Biswa Sarma had to crack the whip on errant doctors but he also offered them a better deal. But in the six other states, health ministers are not even clued in to the problems besetting the health sector. Every now and then, newspaper offices get letters complaining of how they took a patient to the community health centres (CHC) or the primary health centres (PHC) and found no doctor there. They finally had to take the patient to a private hospital or nursing home where, we are told, the healthcare is more personal and immediate but the cost phenomenal. At least some people are taking the more legitimate route of complaining to the media about their hardships. But beyond a point people are not going to take any more nonsense even from doctors who they used to consider their gods.

Healthcare malaise

Time was when you had a local neighbourhood doctor who looked after your aches and pains. Going to the hospital meant a medical emergency. But today, people too look for specialists to confide their medical history in. Women with gynaecological problems will obviously visit the most learned and reputed gynaecologist. The more the specialists are sought after, the greater is the rush for MBBS doctors to complete their post-graduation in the most paying speciality. We find very few general practitioners today. If they are there it is not because they have consciously chosen to practice general medicine but because the opportunity to enrol in a PG course has not presented itself.

The question then is whether we will have general practitioners to look after the common health problems, especially in rural areas. I am not saying that we do not need specialists. Of course we do. We need a dental surgeon to give our teeth a good makeover and an ophthalmologist to tell us what exactly is wrong with our eyes. The problem is that there are too many specialists in some areas of medicine which are more lucrative but very few in the public health sector which is where the problem lies. The objective of specialising is no longer “in the service of humanity.” It’s more to do with padding up “bank balances”.

It is, therefore, not an entirely unkind cut to say that these days healthcare is not just specialised but a profitable business as well. Just look at the number of healthcare centres that have come up in our region, particularly in Assam and the hard advertisement drive they are on and you begin to wonder why they have to hardsell themselves. If a hospital is providing good healthcare, word-of-mouth is enough to spread the good word. When doctors and hospitals begin to package and sell themselves like products, then there is something seriously wrong in the very ideology of this noble profession. The public anger against doctors is mounting and doctors need to ask themselves if they lost their ethics in the momentum of pursuing lucre instead of providing life and health to those they had intended to serve when they joined the profession.

Hailing ignorance

One is not just appalled but also amused by the sheer number of diagnostic centres that have sprung up around all district headquarters and state capitals of the Northeast. Patients who are too ignorant to ask questions and believe what the doctor says is “gospel” are turned into guinea pigs. In nursing homes, it is the rule, not the exception, that if you complain of a stomach aliment, even before you can count three the doctor has already written a prescription for an ultrasonography which is done by one of the doctors within the premises. It is a seamless arrangement and people are in any case too “weak” to protest, much less to ask if the ultrasonography is really necessary. A patient who asks too many questions is considered pesky. Doctors keep them at arm’s length. And yet, is that not our right as patients who pay for the services rendered?

It’s not very different when you enter a government-run facility. There most often the ultra-sound or X-ray machine has gone kaput; has not been repaired and restored in months. So the doctors tell patients to go to some private facility. And guess what happens? For every patient referred to that diagnostic centre, the doctor referee gets a cut. Smooth operation this! One fails to understand why governments procure sophisticated machinery without the warranty and guarantee to provide quick maintenance when required. But then, isn’t procurement of medical equipment in itself a huge racket? Look at the quantum of corruption in the National Rural Health Mission (NRHM) in Uttar Pradesh. It amounts to a whopping Rs 8,000 crore! The CBI is busy right now conducting its operations. People at the helm of the scheme have been netted for now. Some relief that! But do we think it is any different even in our region? The amounts may be smaller in comparison but the corruption in the health sector is rampant.

Time to gear up

At a recent function to upgrade the health facilities of one of the oldest hospitals in Shillong, Meghalaya chief minister Mukul Sangma sent a very clear message to the medical fraternity. He told them to have a heart for the poor and stop prescribing branded drugs pushed by multinational drugs companies but to go in for more affordable but equally effective generic drugs. A medical practitioner himself, Sangma is well aware of the problems in the health sector. But he is not the health minister and therefore has limited options to pursue a more enlightened health policy. Assam, on the other hand, has achieved remarkable strides in the health sector, courtesy its minister Himanta Biswa Sarma. What he has done to turn around the health and education sectors is noteworthy.

Public rage today is like a thawing glacier. It is taking the world by storm. The poor are finding their voice and they cannot be taken for granted any more. After all, they are poor for a reason. The reason is that what’s due to them has gone into the pockets of the governing elite (politicians-bureaucrats-businessman). For a very long time, and perhaps even today, the drug-supplying lobby has held both the national and state governments captive. They have made their billions. It is time this racket stopped and health is delivered as it should be by men and women of character who have some love for humankind! People must make themselves heard and take charge of the health sector.

Democracy is played by the rules. It’s pointless killing or beating up doctors in rage and frustration. Let’s use that rage to make doctors accountable.

(The writer can be contacted at patricia17@rediffmail.com)