``I swear to fulfill, to the best of my ability and judgment, this covenant. For the benefit of the sick I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. I will prevent disease whenever I can, for prevention is preferable to cure.'' -- Hippocratic Oath-Modern Version.
When the medicos say this, turn their black caps from right to left, they adorn the white coat and hang the steths to do the most for their humble profession. The profession has faced many challenges in the last few years. The doctor-patient relationships are rapidly changing. Patients learn more on medicine from the internet and television shows. And many doctors encourage them to do so as it makes them take responsible decisions for their health and health-care decisions.
AdvertisementAdd to this the recent advent of Telemedicine - availability of the best doctors, anywhere in the world and at any time all in the virtual world of medicine. Telemedicine promises to bridge the gap between the rural and urban divide and give the required momentum to the 'health for all' slogan of Government of India.
We celebrate our 60 years of Independence tomorrow on 15th Aug 2007. We bring you special feature on how far has India taken care of the health needs of its people. We bring e-interviews with Indians who have a passion for this sector. Here are the voices of some of the doctors on the challenges that they face.
Dr T K Parthasarathy is a pioneer in medical education who has seen it all. A surgeon trained in the USA , he has been responsible in shaping many medical institutions in India and abroad. He is presently the Pro-Chancellor at Sri Ramachandra Medical University, Chennai. He has unflinching faith in the India spirit. He opines -
As someone who was there when India became independent in 1947 and having experienced the joy as each year unfolded since then, I feel privileged to open my mind and say something on the eve of our 60th year of independence.
Those were the days when we were semi-starved. The eight-ounce rice ration and the black marketeering that prevailed only filled the stomachs of the riches. This provided the possible trigger to achieve self sufficiency in food and the march towards the green revolution. Maybe the semi-starvation was a blessing in disguise.
Now, human spirit, adventure, and entrepreneurship have all reached an all time high. Although not yet available to everyone in India the heights reached in health-care delivery is able to reverse the flow of patients even from advanced countries to India.
Today, patients from America, UK and other advanced nations are visiting hospitals in India to successfully undergo complicated surgeries. This reverse flow of patients from abroad has also fuelled medical tourism in the country.
Besides, research, education and business have taken quantum leaps several times over. The youngsters today exhibit a sense of pride and joy. India overturned the economic picture of doom portrayed by Galbraith of USA several years ago. He had no idea of the intelligence, resilience and determination of the Indian youth.
The shining examples of private enterprise in every walk of life are obvious to any observer. For example today almost one out of five major medical institutions or hospitals are privately managed. The corporate sector in the area of health has grown exponentially but the growth is not uniform in all Indian states. The states that are high in literacy have shown a remarkable progress in all sectors including health and the states where the literacy is low having lagged behind generally.
Nonetheless, 60 years later we can say that we are proud and have accomplished very much; although we are yet to see this reach every corner and every village in the country. But then we have the will to make it happen.
Dr Devi Shetty, is well known Cardiac Surgeon from Naryana Hrudalaya in Bangalore. He is the innovator of affordable health insurance scheme in Karnataka state. His dream is to provide the best healthcare at the most affordable costs to help the common man. These are his views -
I am proud to be a doctor. The greatest challenge before me today is that at least 90 per cent of the people in this country cannot afford treatment for many diseases, particularly heart. The advanced treatment and drugs have proved to have medical advantages but remain inaccessible.
I have been working on projects like a 5000-bed hospital through which, I believe, the cost would come down at least by 60 per cent. I am waiting for that day.
Dr Mohan Thomas is a consultant Plastic Surgeon with Breach Candy Hospital, Mumbai. He is an advisory to the Ministry of Health, Government of India. He has worked for 15 years in the US. His last assignment in the US was Mount Sinai Hospital, New York. He looks at the changing attitudes in India to the upcoming field of Cosmetic Surgery in India. This is one area where many corporate hospitals in India make to make mega-bucks from the growing medical tourism Industry that is likely to produce revenues over 2 billion dollars by 2012. This form of surgery is prohibitively expensive in the west.
Views of Dr.Mohan Thomas on changing attitudes to cosmetic surgery in India -
Wayback in 1947, when someone in India had to do a nose-job, he would go to England. It was a taboo in those days to talk about nose-jobs, face-lifts, hair transplant and breast implant. We were a conservative country. In 1947, only the rich could afford a cosmetic surgery.
But in the 70s, 80s and 90s, people used to talk about nose job, breast implant in a hush-hush manner.
But because of poorly-trained doctors in India, the industry did not see an upward trend and cosmetic surgery was not looked in a positive way.
So, between 1947-2000, the trend was to go abroad for a cosmetic surgery.
From 2000 till now, there has been "quantum leap" in the number of people enquiring about cosmetic surgery. Now, the number of people who can afford a cosmetic surgery has gone up. The number of people enquiring about cosmetic surgery in my clinic has gone up by 10 times and number of people doing cosmetic surgery has gone up by three-fold for me. People are shedding the conservative culture and have begun to talk about it.
Recently, I did breast reduction of a 22-year-old conservative woman from Karnataka. We change the way people look. We change lives.
Blindness is a major problem in India and fortunately an easily preventable problem. Many are blind due to malnutrition and only require a cheap Vitamin such as Vitamin A to cure this state. Dr K Bhujang Shetty, Medical Director, of the Eye Hospital from Bangalore share his agony on this issue -
My biggest worry is the preventable and reversible blindness. I do not know if I should say I am upset or angry at the darkness in people's lives.
At least 50 per cent of reversible blindness is due to cataract. The procedures are very simple and can be carried out at a very low cost. In many cases, it is even done free of cost. Yet, there are many who have not been able to reach the door steps of a hospital because they are unaware.
Add to this preventable blindness like Glaucoma and conditions caused due to diabetes. On this day, I would rededicate my self to bring in light in people's lives.
A student spends the maximum number of years to become a doctor but ends up starting at the bottom of the ladder as far as pay scales are concerned. The entrance to the medical colleges is the most competitive in the country. Dr B Ramana Rao - Consultant Physician, Wockhardt Heart Institute from Bangalore shares his views and worried about the future -
I am proud of the oath I have taken. But I am troubled by the decreasing amount of time I am able to spend with my patients. This is not just because more and more people are growing sick but because the numbers of doctors have declined. The quota systems in medical education and low salaries in medical services have only made the situation worse.
With the growing load there is immense pressure on the doctors to satisfy the needs of patients. I try my best to do this with every patient I meet, no matter who he/she is.
In 1947 India had high incidence of infectious diseases like Cholera, Leprosy, Small Pox and Chicken Pox. Today Small Pox is extinct and it is rare to hear p[eople ion the country dying of Cholera. Leprosy is on decline. Dr T P Kalanidhi, Dean, Madras Medical College represents the government sector. Undoubtedly the government's role in medical education and preventive diseases has been laudable. He passionately believes that India has achieved significant milestones in the last 60 years and these are his views -
Over the last 60 years, India has come a long way in the field of medicine. I must say that the strides we have made in health care are excellent. We must rate our recent advances providing facilities in primary and tertiary health care as among the best.
Our Government has made great advances in the field of medical education as well as in creating health awareness on various diseases among the general public. New centres of excellence have come up in medicine. Significantly, the private sector has contributed substantially, supplementing various Government initiatives, over the years in terms of strengthening the health care delivery system throughout the country. This has had a very good impact on the people.
According to me, there are three spheres where we have succeeded as a nation i.e. in the area of preventive medicine, providing services for ailing patients and strengthening medical and paramedical education.
In the initial years of Independence, we found it difficult even to prevent cholera and chicken pox. Today, through concerted efforts we have succeeded in not only preventing the outbreak of these diseases but also established ourselves so well that we hardly hear about communicable diseases.
In addition, I wish to specifically note the advancements made in the south Indian State of Tamil Nadu in these six decades. In Tamil Nadu, we are almost inching towards the goal of achieving a doctor-patient ratio of 1:1000. Besides, patients are in a position to avail treatment within a 100 kilometers radius. Likewise a medical college is available for every 100 kilometers radius geographical area.
These are all achievements that India can certainly be proud.
To critically appraise the health of the country we interviewed an economist who researches the area of health extensively and writes on these issues for WTO. Prof. Rupa Chanda from Indian Institute of Management, Bangalore is disappointed at the public sector's performance and strongly believes that the current corporatiztion of health in India has happened due to the failure of the public sector. She is cautiously optimistic about the future of the health of India provided the Government gets its act together. These are her thoughts -
I think in 60 years of independence, we have not done much on the healthcare front. This is crudely evident from the low share of spending on healthcare in overall GDP, which falls short of what other developing countries do even in our region. Moreover, there has been abysmal delivery of healthcare by the public sector, as evident from the declining share of public expenditure in total healthcare spending. It is odd that in a poor country like ours, some 75 percent or more of healthcare spending takes place in the private sector. It certainly reflects the poor state of public health infrastructure, poor systems and processes, and the lack of faith among even the poor people to get public healthcare.
As regards corporatization of the health sector, it has happened because of the public sector's failure. However, one major problem is lack of standardization and proper regulation and monitoring of who the players are, especially the mid and small size private players. A number of nursing homes and clinics have mushroomed and there are a large number of quacks. What it reflects is that the consumer interests are certainly not being protected adequately.
As far as the larger players are concerned, this is not necessarily a bad development if healthcare costs are kept at affordable rates, but given the huge costs of such players and their investments in technology, land, equipment, and remuneration to personnel, costs are likely to go up with greater presence of such players. The only way such healthcare can be kept at affordable rates is if some form of national health insurance coverage is available or through some community funded insurance schemes at low premium. Also, if the scale of such hospitals can be expanded (5,000 beds plus), if set up and operating costs could be alleviated (through land subsidies or Public private partnerships), then this could translate into lower delivery costs.
There are many positive implications of the corporatization of healthcare in terms of standards, practices, technology, reversal of brain drain, etc. but much depends on regulation to check the mushrooming of lower standard delivery centers. Also, the government needs to revisit its policy on managing public hospitals through partnership arrangements with the private sector and also to rethink its policies on medical education to expand manpower where we are going to face problems of quantity and quality. The healthcare sector is quite open and FDI and other forms of foreign investment are permitted liberally, and yet not that much is flowing in yet. This is mainly because of internal constraints which are affecting the profitability of this sector.
According to the World Health report in 2003, the developed countries that account for less than 20 per cent of the world's population in the year 2000 were responsible for almost 90 per cent of the world's health spending. This translates to mean that that eighty percent of the world's population spent only 10 per cent of the total expenditure on health. And in this 80% are the people from the Asia-Pacific as well as African and Latin American countries. There are innumerable issues that needs to be tackled but the ones that take prominence and require our attention in the coming decade include:
· Zero-level growth of HIV/AIDS
· Tackle TB, Malaria and reduce its mortality by 50 percent
· Improve the utilization of public health-care facilities
· Improve the Infant and maternal mortality rates
· Provide sanitation and clean drinking water
The priority of independent India is slowly changing. As India progresses and marches towards the developed nation status there is likely to be more spending of the GDP towards health. The public sector accounts for about 18 percent of the overall health spending and 0.9 percent of the GDP. The private sector plays a dominant role and accounts for about 82 percent of the overall health expenditure and 4.2 percent of the GDP. It is to be seen how the current coalition government in India at the centre prioritizes the health of nation in the years to come. The health issue is complex and is interlinked with many other issues, however health is one area where the dissent is likely to be least from various coalition parties ruling the centre - after all health is important to all and is the basic right of every citizen of the country.
Pablo Picasso once remarked: "One starts to get young at the age of 60." The Indian private healthcare industry in India is young and needs nurturing, direction and guidelines and the government has an important part to play. It needs to come out of its beurocratic shackles and political compulsions to work with the private sector and create public private partnerships to make health affordable to the common man. The telemedicine projects with ISRO have great potential if properly guided. There is a will in the country today. We have the best healthcare professionals in the world managing many national health services and many would love to come back home if given an opportunity. It is Advantage India time now.
(Editors Note - If you wish to share your views on the subject - write to us or use the comments box.)
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