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If poor are 'empowered' with govt healthcare, they wouldn't go to charity for help

By Dr Maya Valecha*
Let us understand each issue point by point. First of all I must thank you for initiating this mind churning discussion. It’s your response that has started discussion.
Let me make it clear right in the beginning that what is being proposed right now is that the huge resources of our country, material and human in private hands, specially in allopathy, to be taken to serve the public interest, because that resource is built by public money in the form of loans and used for many unnecessary investigations, drugs and surgeries.
What to do with good charity hospitals should be left to the people of that area. If people are happy with them, let them be. And whenever required they should be given more help and funds. They are a minuscule of the whole healthcare apparatus.
Big ayurvedic and homeopathy hospitals would come in the category of specialty or super-specialty hospitals, I am not sure how many but quite a lot of them would be government run even today. For that, basic doctors should know and understand these practices as scientific. 
Existing small private practitioners of indigenous medicines can be provided separate out-patient department (OPD) at all levels of government hospitals, sub-centres in villages, primary health centres (PHC) to District level hospitals.
That is why I have suggested the need to learn all, allopathy, ayurved, and homeopathy, even unani at undergraduate level by all students and do specialization in any of them at post-graduate level. Today majority of the allopathic doctors do not recognize other branches as even scientific. Monetary interests play a major role in spreading this myth. This is in spite of the Aayush department.
Right now ayurvedic and homeopathy students are given basic knowledge of allopathy. Majority of them work in allopathic private nursing homes in the initial years. (There, the private allopathy doctors don’t mind using them as they have to pay less but on every other platform they don’t recognize them.)
Today the patient who has no knowledge of any branch decides where to go as trial and error method or out of economic compulsion and availability. Instead, if all doctors have basic knowledge of all the ‘pathies’, they can guide the patient as per the requirement. The way yoga and acupuncture are being adopted by physiotherapists, other branches of medicine should be given equal status.
But still let us be very clear, charity came in existence because the government abdicated its duty to provide healthcare to all, remote areas included. Some of them might be running very good but I have worked for three months in a very old charity hospital in the heart of the city where primary instruments for a gynaecological inspection were not there in OPD and the table also not suited to gynaecological examination.
Because I was young at that time, some thought that because I am inexperienced I need more instruments! Many charity hospitals feel funds crunch. And if they are not part of the robust healthcare system, how to monitor the standard there, is an issue. Poor patients going there would not understand this.
Also the way even poor feel empowered and understand their right in a government hospital, they would not demand in a charity hospital. Those who want to do charity can provide services in the government hospital, with their name on the board there.
Drugs bill, payment of staff, anything they want to, after such ill-managed hospitals because of fund crunch are taken over by government. But a uniform high standard treatment for all is the goal, and not different standard for poor and rich.
Demilitarization? Yes. These days I am putting on all social media platforms whenever I get a chance: 'People of China and India should pressurize their governments to stop all fighting. We want peace. All ice laden ecofragile region, full of glaciers be declared as No Wo/man’s Land. Let us remember poet Atal Behari Vajpayee’s poem, “Hum Jung Na Hone Denge”. Because the war or war- like situation is the ground for arms purchase and commission.'
I agree nationalization in Cuba came with revolution but even under the pressure of socialist countries nationalization was done in many capitalist countries and was running fine till 1990. After that, during liberalization, this weakening of government institution started. But they are still much better.
BJP is having doctors’ cell. It works to fulfill their demand. Majority of private doctors are BJP members in Gujarat. Will they advise to strengthen the public sector?
I would like to have revolution today but we don’t have an organization strong enough and thereby people ready to bring revolution. Our immediate demands should be such that it explains the need for revolution in long term. So if demand does not include the need to use private resource it will not educate people further.
Politics and healthcare are not two different entities. Not only the fact that politics is economics by other means, but BJP is having their doctors’ cell. The way women’s cell is to fulfill women’s demands, this works to fulfill their demand. Majority of private doctors are BJP members in Gujarat. Will they advise to strengthen the public sector? Other parties I don’t know.
After Independence, like all other sectors, it was the government which was running hospitals in India, and we already have a prescribed structure of primary, secondary and tertiary healthcare structure. The best equipment and best brains were supposed to be in government hospitals at that time. 
But like in every other field with the rise of private sector, the public sector is neglected, big private sharks would not let the public institutions survive. All debates are managed with the intention to decrease government spending.
It works at many levels. Apart from policy levels, drugs meant for government hospitals being diverted to private hands (stolen), because private avenue to sell is available, a big anesthisia trolley being stolen from a hospital attached to a medical college. Who can use it?
Now comes compassion. There is a book named ‘Spirit Level’, the authors have done 40 years study of mainly developed countries (because of reliable data available) and concluded that empathy, trust towards fellow citizens is more where inequality is less. Many other things were studied crime rates to teen pregnancy to death penalty.
I just recently met a doctor who has studied her medicine in China. Among other things I specifically asked about the behaviour of doctors and other staff towards patients, and she described it to be polite, human, full of empathy. 
So nationalized does not mean bad. They were crowded but neat and clean, patients being guided well and so on. She has finished her studies in 2013. Once the attraction of vulgar money earning is gone more people with service orientation would come to medicine. Also there will be supervision.
I have particularly described in the draft how it would not be bureaucracy but people’s democratic local control along with medical staff that will govern the hospital. When we create a strong public opinion and then a movement, people will be well aware to do that.
I totally agree about health, environment and economics. I have mentioned even to include environmental science in medical education and beware of the corona and other pathogens have their origin in climate change, deforestation.
Let me tell one last thing that with this primary draft I am getting huge positive response on WhatsApp, Twitter and emails. Facebook just started. May add Instagram. The group here has people from different states and Hindi translation is already done. Gujarati and Tamil are about to get finished.
A person in Mumbai just after reading it on site has offered to translate in Marathi. It’s not just the middle class. The staff here in a housekeeping contract is from UP, Bihar, Bengal and they all read it and say, “Sahi Aavaz Uthai Hai”. I tell them to send the same to their native. WhatsApp has changed the world. My contacts from slum work have gone back to their native. I started sending to them from yesterday and awaiting response.
Two offers for arranging webinars one from Indore and one from Pune are in the pipeline. Local webinars in Gujarat are on. So people are ready. Some who were pucca bhakts, so far have responded positively.
Publication of the draft in Counterview has definitely helped.
---
*Gynaecologist and activist. This is in reply to film maker-activist KP Sasi's comment "Healthcare: Total nationalisation can mean 'strengthening' bureaucracy, state power", published in Counterview in response to a draft note by Dr Valecha advocating nationalisation of healthcare in India

Comments

KP Sasi said…
If poor are empowered with nutritious food, healthy environment and water, they would not even need the existing hospitals.
Dr Maya Valecha said…
To a large extent yes. But some ailments still occur. For example appendicitis. So we need hospitals but Preventive and Social Medicine which is taught in all the years is not in practice anywhere.

I even feel that only malnourished chronically ill children die of measles. We need nutrition, hygiene, not vaccine. Same to a large extent polio.

I take zoom meetings to discuss HPV vaccine given by doctors to young girls in cities telling even lies in the process. Even schools are involved in this vaccine propaganda. And the case is still pending in SC. Private interest!
KP Sasi said…
There are several traditional possibilities of cure for appendicitis. You don't need hospitals for this. The real Preventive and Social Medicine today is being practiced in traditional villages and among Adivasi communities. These systems of knowledge are deteriorating with modern health problems coming up due to the nature of our development model. Apart from that, both private and Government hospitals and their infra structure act as an invasion on their traditional knowledge on health care. There is a need to strengthen it. Your vision of solving the problem of health in India through Nationalisation is not an answer to it. India today does not have the prior conditions for it to bring results. For example, I would argue that the implementation of Haathi Commission Report is a must before any nationalisation. It means, proper production and distribution of essential drugs and removal of non-essential, spurious, non essential and banned pharmaceutical drugs from the market. If we do not do that, the pharmaceutical drugs themselves can continue to generate health problems. During the eighties, a team of people oriented doctors under the banner of All India Drug Action Network was active in this direction. Now, that network does not exist. I had made a documentary film on these issues with this network. It is called In the Name of Medicine. So long as the hospitals are dependent on a profit oriented drug production, nationalisation of hospitals becomes meaningless.
Dr Maya Valecha said…
I understand your concerns.

I accept my ignorance about many traditional indigenous practices of preventive and social medicine. Because our medical colleges dominated by this profit oriented allopathy don't teach that and everybody doesn't get that chance in life to get that exposure. I took some middle class people staying in city to slums, they had never visited a slum in their life.

But as I understand the vested interests of allopathy, pharmaceutical industry included, are the primary reason for invasion on these traditional knowledge system. I explained about this in context of homeopathy and Ayurveda.

PLEASE NOTE,
Nationalization does not mean imposing allopathy everywhere.

Exactly opposite to that, if our whole attention is the health of the people and not profit, with active participation of all who want to contribute positively, like you are having so much knowledge about traditional practices, we can bring those things to mainstream knowledge. And avoid so called modern drugs which are harmful.

I tell people that because I am trained in allopathy, I know all its negative aspects. I myself and my daughter use homeopathy for last more than 15 years.

I can't keep on giving you certificate about myself but because I am in a position to impress upon people about many things and the way I propagate about environment protection to so many other points you raise that I feel I don't know how to tell you that I am not that dogmatic person you probably imagine.

But with the private health industry for profit, working as it is, sabotaging in all ways the real health of the people, none of your concerns can be addressed.

And only when by nationalization with people's direct local Democratic control is brought about, the healthcare can be reorganized for the benefit of people using all other practices other than allopathy, including indigenous you talk about.

About drug production and all that only solution is take out private profit by nationalization and DIRECT DEMOCRATIC LOCAL CONTROL.

Unknown said…
I get Mayaji's point that a nationalized healthcare system would empower the middle and lower strata of people. Also Sasiji has a point that we need to emphasize nutrition and then a Health Care system would be less needed. True even that. But inspite of the best intentions, health does take a hit and having a nationalised system of care in place would mean affordable and reachable access for the greater population. Privatisation of systems have proven to have failed the general public at large in terms of cost and quality both. Mayaji does not only mean nationalised healthcare has to be allopathy based alone, and that I find very refreshing. Provision of the full spectrum of healing methods at a nationalised level would keep the extreme end of the corruption that we see in the current Health care industry, in check and the public at large could have a lot to gain. I would also like to add I know very little and I don't feel i am informed enough to say much more than this.
Sourav Ghosh said…
I agree with all the comments above. However, I would also like to add 2 points-
1) Rajiv Dixit jee wanted ayurveda reintroduced to schools/gurukuls. He shifted from his focus from allopathy to ayurveda in view of the cases and doctors ratio. He said that 80-85% of the cases can be treated by the patients themselves with some basic knowledge. He also mentioned the ancient practice of village vaidyas and Health insurance from every home. The daily sendings stopped as soon as a family member got ill. The offerings restarted when the entire family was healthy again. Just saying because this is related too, to the malpractices arising from greed. Some thing can come out from this.
2) Most of the abuses of the system arise from the higher strata of corporatocracy and oligarchy. The oligarchy of the elites guides the big corporations they own, and controls the corporatocracy. The layer of democracy suffers under these two. The fourth layer is of homeless people, war refugees, slaves, kidnapped people, Targeted individuals, etc. They are deprived of basic human rights, civic rights and democratic rights. However, the entire system comprising of four layers is a plutocracy based on fiat currency (due to collapse soon). The society is not free from evil, and only education can create a mass of responsible citizens who can protect the healthcare system from falling into the hands of the goons and political leaders.

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