Canis Lupus Dear Editor,It is a good thing you have started a discussion on a topic which affects us all at one time or another – health care. Unfortunately, a person rarely bothers about this except when circumstances force a visit to the hospital.I’ve observed some things about hospitals and doctors which may have a bearing on the subject.Medical education has become expensive and time consuming.There was a time when you got your MBBS in five years and got down to practising. Now it seems you have to specialise in some thing or the other in order to succeed. The costs will obviously be recovered from the patients afterwards. Moreover, the professional colleges have quite a brutal culture of ragging. This serves to extinguish the sparks of humanity in many aspiring doctors – sparks which may not have been too bright in the first place. This greatly helps in building a successful career later in life: you don’t let silly concepts like ethics and conscience come in the way of making lots of money.A government doctor’s salary is peanuts compared to the earnings of a successful private doctor.For an ordinary Indian who merely ekes out a living, a government job is the Promised Land. Heaven, for us, is sitting in a shabby room with cracked window-panes, a large table and the Chief Minister’s picture beaming down from the whitewashed walls. A government doctor has a cushy job, we would say. Nice pay, nice perks, Class I status, a sarkari quarter, a pension later on… And yet govt. doctors – specialist mostly – leave their jobs as soon as they can and join a private hospital.I live in one of the Himalayan states with a sparse population. Our district town has a large government Zonal Hospital with a spanking new wing recently added. This hospital has almost everything a hospital in the interiors would desire. In fact, if a doctor wants plenty of practice in his chosen profession, there may even be patients on folding beds in the aisles, corridors and stairwells. Everything, that is, except for enough doctors. They just don’t exist. It looks like nobody wants to work there. It is more or less a skeleton staff that’s running the place. There has even been the somewhat bizarre instance of an eye doctor attending to accident victims (since he was the one on night duty, there being nobody else). This is probably the case in all other government hospitals.One doctor I know, who used to work there, resigned a few years ago to join a private hospital not one kilometre away. He confided to a mutual friend: “Yaar, in the old job I got regular pay and thought I was lucky I had a Maruti 800. Now, hardly one year into this job, I already have that sleek Honda City. And next year I’m going to change it.â€Private hospitals are efficient. But they are in it for the money.Understandably, they aren't in it for charity. One shouldn't grudge paying them an extra penny for good quality care. Ah, but these are the tricky words: good quality care,The new born infant of a cousin had some birth defect and was referred to a specialist’s private clinic. The kid was put into an incubator and everyone was shooed out. After a few hours the doctor says they need a bottle of A positive blood. My cousin is A positive and I drove him to another private clinic to be bled. When we returned with the blood, the doctor quickly took the bottle and put it in the storage. Then he told us the child was dead. The bill was formidable.The daughter of another cousin had an accident riding her two-wheeler and suffered head injuries. Friends allege that the private hospital they took her to, kept her brain dead body artificially alive for three days in the ICU. ICU charges, of course, formed a hefty portion of the bill. The said cousin doesn’t have a very successful shop and had to raise the money Somehow (which is how it always is with anything in India: it has to be done Somehow).Sending patients off for needless tests are already old hat. Likewise for putting pacemakers and stents into patients without any particular need. That means we were better off with the government hospitals, no?How good are the government hospitals?They are overflowing with suffering humanity. Suffering humanity includes the patients, their relatives (who have to double as nurses and general fetchers of things, carriers of bedpans and moppers-up of vomit), and even the hospital staff. The former and the relatives get to leave sooner or later, even if dead. The staff has no such option. So they tend to start taking a short cut or two, and getting a little snappish. A cousin (yea, I have an army of them) was diagnosed with hepatitis C and referred to a government hospital in Chandigarh. My brother went with them because he thought he knew the hospital layout somewhat. They were given a short little welcome speech by a doctor. This, within the hearing of the patient: “You ignorant simpletons from the hills come here when the patient is about to die. This girl will die here!†(She did, as a matter of fact. But not before purgatory which all of them underwent for some days). The hospital ran tests after tests. In most cases my brother had to run about with the samples to various rooms and departments. Where ever he went he was yelled at, snapped at and scolded. In the end he was so fed up that when he went with yet another sample to yet another room he glumly said, “Please get your yelling over and done with first, before I tell you why I am here.†He was somewhat surprised when the lady in the room just smiled and quietly took the sample and paper.So that leaves the quacks and chemist shopsThe quacks, unqualified “doctors†and even medicine shops have a flourishing medical practice. Why? Because they do have that reassuring bedside manner. People can be forgiven for going straight to them when they fall ill. The service is quick, the guy is unfailingly polite, and may even have a neater hand putting in stitches, setting bones or pushing in injection needles. I should know: I’ve once had my broken foot set by a barber (my limp didn’t leave me for almost a year after that, though) and at another time had injections given by a veterinarian’s assistant. For other medical emergencies people make a beeline to the friendly chemist’s shop. He is thought to know all the medicines which the doctors prescribe for the various illnesses anyway. So why put the doctor in the loop?I won't say much about the homeopaths, sorcerers and holy men, because they come later, as a kind of court of final appeal. However, some of them do wield a mean hatchet when skinning their victims. Some years back, a distant uncle in the final stages of cancer fell into the clutches of one such combination sorcerer-holy man. Two years later his widow was still paying off the debts.Which is the better option?This leaves one wondering, which is the lesser evil? The private hospitals, the government ones or the quacks? I really don’t have an answer. I would leave that to the brainier citizens. However, just a few days ago there was an interesting suggestion from a Pakistani in the Karachi paper Express Tribune. The writer of this Letter to the Editor suggests that there should be a Medical Ombudsman. I think this is a very good idea. Perhaps we can have such an official at the State level. The Ombudsman can be appealed to in the type of cases which mostly, at present, end up with the patient’s friends and relations creating a ruckus and smashing things.There are good doctorsBut you have to be lucky to find them. They may be found in the unlikeliest of places, like way-out dispensaries with a drunken compounder, few medicines and stray dogs in the veranda. (I’ve seen one such; he was there as a punishment posting). In Shimla there was an old and respected doctor, Dr. Mukand Lal. He became a doctor during the British Raj and stopped practicing when he grew too old and was pushing a hundred. And when he died almost all of Shimla shut down for the funeral. That's how respected he was.Canis Lupus is a resident of a village in Kullu district, Himachal Pradesh.The opinions expressed in this articles are the personal opinions of the author. 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