There has been a lot of talk about the abysmal status of the Indian health scenario. About the widening chasm between the rural and urban health care, the stark comparison between the public and private sectors, and so on. But haven't we progressed?
I interned at the Kolkata Government Hospital, which was frequented more by the local Muslims. I remember my obstetrics intern days. Most women visited the hospital for the first time on the verge of delivery. They had not even heard of ante-natal check-up. Most of them were anaemic with pedal oedema. I still recall a 17-year-old girl, who died of haemorrhage after an abortion done by a quack.
The scene has definitely changed now, at least in urban areas. Household workers and their families in my neighbourhood regularly go for ante-natal check-ups. I have not heard of any child or maternal casualty among them.
In 1991, I had a stint at the Vijaya Health Centre, Chennai. Once, an attender came to me with a ganglion in his left wrist. He was not medically covered by the hospital. But I could not shun him. So we personally took care of the expenses, and he was successfully operated upon.
Earlier this year, the same person came to me with an 8cm non-malignant brain tumour. A surgery was needed. But it would have cost him at least 05 lakh at the private hospital where I was working. All he had was 039,000 from the Chief Minister's Health Insurance Scheme under the Tamil Nadu government. With that, I operated on him at the SRM Speciality Hospital at Kattankulathur. And soon he went home—cured and happy—thanks to the new government scheme.
Another case I recall is from my surgical internship days. A 39-year-old lady came to OPD. She bared her chest, and in place of one breast was a large, foul-smelling, fungating tumour.
Now in 2012, even slum-dwellers get mammography and ultrasound done for tumours in the breast at a much earlier stage.
So a lot has happened in our health scene. But is it enough? The unfortunate answer is NO.
When we compare the Indian health scenario with the global scene, even in the basic health care indicators, the picture is grim (see box). In case of infrastructure, we fare much worse than not just developed countries but developing ones, too.
However, let us look on the bright side. The health field has its fair share of private sector involvement and, recently, 51 per cent foreign direct investment became a reality. This means newer techniques, equipment and tie-ups.
Our medical colleges—government and self-financing—are keen on tie-ups with renowned foreign universities. These open up the doors of exchange programmes, better research facilities and training.
Leading private hospitals have made modern treatment available in India. But this is available only to a select few who can afford it. Thus, improvement of medical insurance schemes and wide application of government insurance schemes are crucial.
The government gives many privileges to the private sector in the form of low-cost land, less taxation and low customs duty, in exchange for a certain number of free beds. This system has to be scrutinised stringently and private-public partnership has to be strengthened.
Currently, the involvement of the IT sector in medical field has made ‘treatment from distance' a reality. With wider use of tele-medicine, expert opinion can be availed at rural centres. The basic IT infrastructure is not very expensive and the manpower required is minimal.
In Tripura, for instance, tele-medicine has been introduced in ophthalmology. Optometrists treat patients with the help of Aravind Eye Hospital, Madurai, and only complicated cases are referred to government hospitals. The same system is going to be introduced in Bankura and Paschim Midnapur in West Bengal, too.
India has the unfortunate load of dual-diseases. On the one hand, there are communicable diseases such as tuberculosis, malaria, dengue and cholera. And on the other, there is a rapid increase in life-style related diseases such as cardiovascular ailments, cancer, diabetes and chronic obstructive pulmonary disease.
There has to be a strong thrust on preventing communicable diseases. Better infection-control policy and preventive measures are required. Judicial use of antibiotics in correct and adequate dosages may be the key for a better future. Look at polio: thanks to the Pulse Polio campaign, the disease has been almost eradicated.
In the case of lifestyle-related diseases, improvement is seen in many fields. Advanced radiology diagnoses cardiac diseases and cancer at a much earlier stage. Improved biochemical tests, too, help in early diagnosis.
Newer techniques like minimally-invasive and robotic surgeries offer better care and comfort to patients. New chemotherapeutic drugs are being discovered by the day. And with the recent complete gene mapping of a tumour, complete targeted therapy is likely to be a reality soon.
Furthermore, many new drugs are being used for effective control of diabetes. Development in interventional radiology makes stenting of almost any block and embolisation of almost any bleeding possible. Linear accelerator, cyber-knife, gamma-knife, Novalis—the newer acumen of radiation therapy—make the process faster and more effective, with minimal side-effects.
Thus, we are certainly looking at better prospect all over the health sector. But the most important task is to make it available to everybody. With new medical colleges, nursing institutes and paramedical courses, the discrepancies in their numbers should diminish. Better insurance schemes will, however, hold the key to the Indian health sector's success story. A brighter future awaits us. In a not-too-distant future.
Ghosh is CEO & director, department of neurosciences, SRM Institute for Medical Sciences .