Missing the woods for the trees

In March this year, an IAS officer in Jharkhand gave birth to her baby at a government hospital. That this made front page news nationally and that too valorised, is not surprising. Because in India, it is an unusual act. Almost a brave one.

Sanjay Nagral
Aug 7 22, 2020, Mumbai Mirror

In March this year, an IAS officer in Jharkhand gave birth to her baby at a government hospital instead of a private hospital. The news was front-paged by national newspapers. After her successful delivery, officials congratulated her. They praised her for her gesture of going to a government hospital. That this was news and that too valorised is not surprising. Because in India it is an unusual act. Almost a brave one.

Almost all VIPs affected by Covid across the country have been admitted to private hospitals. The list starts from the Home Minister to chief ministers, governors and bureaucrats. In Maharashtra, three cabinet ministers were treated in large private hospitals in Mumbai. Even in Delhi, the health minister was initially treated in a government hospital but was quickly transferred to a private one, allegedly for plasma therapy. In West Bengal, senior leaders of the Left Front are also being treated in government hospitals. There is complete political consensus on this issue.

Every time a politician or a bureaucrat is treated in a private hospital, there is outrage and criticism. There are calls that it should be compulsory for them to seek treatment in public hospitals. There is much pontification that they should be doing so since these institutions are run under their watch. There is a view that public hospitals will naturally improve if political leaders are forced to get treated there.

Doesn’t any individual, minister or otherwise, have the right to be treated at a hospital of his or her choice? Moreover, isn’t it true that in today’s India everyone who can afford them – perhaps even with difficulty – prefers to get treated in private hospitals? I am afraid most of us would do the same. Then why this duplicity in singling out VIPs?

Of course, government officials need to be accountable as their treatment is funded from the public exchequer. And they are often said to misuse this for unnecessary hospitalisation. The message that if VIPs chose private hospitals they must be better, impacts public opinion.

Once on a round in a public hospital, a patient told me, ‘Sir this ward is very hot. The fans are not working’. ‘Did you tell the nurses or ward boys?’ I asked. ‘Yes, I did but they say if I want such comforts I should go to a private facility’, the patient said. I have often heard patients being told ‘If you want an earlier test, go to a private hospital’ or ‘Why are you complaining about a clean toilet. Don’t be demanding. This is a public hospital’. This association of public hospitals with crowds, delays, lack of privacy and hygiene has been rationalised. When patients in our surgical ward are not doing well, they often say, ‘Could you shift me to private. I will manage to pay’. Free care is also associated with poor care. By everyone.

This is an awkward situation. Part of a larger conundrum we face in a sharply divided society. Based on history, we know that in spheres like health, education, transport it is strong, public institutions that serve everyone at an affordable price. If we critique their inadequacies, we can be called out for hypocrisy, as we are no longer its users. This is a bit simplistic and even disingenuous. Do we have a right to critique our public services even though we are currently not a user? If we don’t inhabit low cost housing, public transport, government schools, do we therefore lose the right to criticise them?

The high costs and excessive care in the private sector are very real. But so also is the lack of hygiene, uncomfortable wards and delays in the public sector. India’s political class has its ear to the ground and is aware that this dichotomy has been normalised and accepted. The poor may have come to terms with it as something preordained. And the elite, though upset by high costs in the private sector, do not want the public sector in its current form.

Covid is gnawing at these beliefs. Every analysis of the pandemic recommends increased funding for public health. That is a given. But there is more needed. An acknowledgement that delivery of sensitive and accountable care in a clean environment is also necessary. This is a bigger challenge than funding.

Tempting as it may sound, symbolic measures like forcing VIPs to use public hospitals will not work. If they indeed do, they will get special treatment, shielding them from reality. It will end up as a photo-op like occasionally wielding brooms or riding a local train.

There is political consensus across all parties on where their leaders will be treated for Covid. So also for all of us, if we can afford them. Our duplicity of waxing eloquent about the stellar role of public medicine but avoiding it when it comes to self is conveying something fundamental. Responding with calls for leaders to be mandatorily treated in public institutions is missing the woods for the trees.