Wishful thinking on the new year
Just as the world was heaving a sigh of relief, recent reports from some countries raise the spectre of another wave (REUTERS)
The 2022-2023 cusp is different thanks to a recent cataclysmic event. The mayhem unleashed by a tiny virus across the world forced some collective thinking
Sanjay Nagral
Jan 2, 2023, Hindustan Times
In the modern life of the globe, the turn of the year now evokes celebratory rituals. It has its uplifting moments. Though the tropes are increasingly optical and predictable. Given the drudgery of everyday life, one understands the collective need for this cathartic jamboree. A mixture of lament, nostalgia, hope, optimism is on public display. The media reflects this in flashback mode. Our personal devices are flooded with ‘Happy new year’ on WhatsApp. And why not, when the ‘send all’ click is so easy?
Does reflection on the year gone by contribute to a better life in the year that follows? Do we collectively learn to improve our daily lives? The rhetoric apart, such questions are too ambitious without the context of period, place and culture. But the 2022-2023 cusp is different thanks to a recent cataclysmic event. The mayhem unleashed by a tiny virus across the world forced some collective thinking. And just as the world was heaving a sigh of relief, recent reports from some countries raise the spectre of another wave. With the geopolitics of the world already poised on a dangerous precipice of war thanks to the Ukraine war, another global attack by this virus could have very different challenges. So, as we wake up with a variety of hangovers after a weekend of celebration, Covid is still on our minds.
What then awaits the megapolis of Mumbai we have made home? As if a city of millions crammed into a tiny island didn’t have other challenges how will we fare in terms of another Covid wave? Has the health system changed? Are we now better prepared for more epidemics? And is what the media dutifully telling us based on the states’ press releases true? Finally, the mother of all questions that one can indulge in given the turn of the year. What are the forebodings on the health front for this city? Permit me to revel in the moment of the New Year headiness for some random thoughts.
Over the last three years, I had the opportunity to write about a plethora of issues around Mumbai’s healthcare through newspapers columns. The good, the bad, the ugly. The historic, the cultural and even stories of patients and their humbling resilience. I started my column just before Covid struck. I forayed into many areas but I had no choice but to come back periodically to Covid. I am not an expert either on infectious disease or Covid. But I had worked well inside the belly of the city’s healthcare beast in its myriad avatars to give a somewhat insider’s view. And even occasionally have the gumption to make predictions. Covid after all was a great metaphor.
But there are some fallacies when writing prescriptions for Mumbai’s healthcare. First that it is in some ways unique and follows a different trajectory from the rest of the country. This is only true to a point. But the notion that somehow Mumbai’s health system is different from the rest and hence performs better has little evidence. The municipal corporations’ medical colleges and teaching hospitals are historically more organised about patient care and training but extrapolating that to the entire health system is convenience. Mumbai’s urban health is as dysfunctional as the rest of India.
But the other fallacy is even more fundamental. When we freely use terms like ‘city’ ‘we’ ‘collective’ for any public good in Mumbai, we are indulging in a certain disingenuity. For this is a city of a multitude of layers of social hierarchy, buying power and access. Upward mobility is exceedingly slow. And this isn’t changing anytime soon .One doesn’t have to be a social scientist or even a bleeding-heart liberal to know this. But for someone like me who has worked across hospitals in private and public sectors this reality is an everyday reminder of a gruesome divide. Whilst homes, cars, schools are the more visible signs of Mumbai’s social divides, healthcare is its relatively hidden secret.
There were periods during Covid when we came tantalisingly close to the idea of health being a collective good. We briefly saw triage of patients through ward wise telephone lines, hospital beds being controlled through a centralised system and capping of costs in the private sector. The much discussed Mumbai model of Covid care could be created because of an extreme crisis which forced those who normally don’t tolerate such interference to fall in line. But of course normalcy returned soon. After all we have all lived in a certain way for decades with the understanding that dichotomy is naturally pre-ordained. And hence even the most well-meaning of our citizens have internalised that there are two types of healthcare which can exist cheek by jowl. One for us and the other for those who work for us.
So do I have any new year wishes for Mumbai’s healthcare? That whilst we may not see a dramatic change there is a small but critical mass of citizens who have begun to appreciate that public policy will be an important determinant of how all of us live healthy and safe lives. And that it is difficult to lead gated lives. From pollution or from the Covid virus. That gardens and parks, the ability to run and walk will determine the obesity epidemic which has crossed class boundaries. And though you may be staying in the swankiest of high-rises, if public services like the fire brigade do not perform, you are a sitting duck. If involved in an accident on a Mumbai road, a well-equipped public ambulance service is what may save you. And that all this has nothing to do with more hospitals or technology. In other words, periodically remembering Covid. A new year wish or maybe even wishful thinking.