SOME OF INDIA's most senior doctors, bureaucrats, journalists, sociologists and others have bared the ugly reality of predator-doctors looting patients across the economic spectrum, from the very rich to the extremely poor, and have narrated the story of utterly broken trust between doctors and patients.
Full of scandalous stories that name even top notch hospitals and well-known doctors, a new explosive book published by the Oxford University Press is creating waves in the medical fraternity as well as general public with its candid portrayal of how patients feel cheated by doctors and hospitals every single day in every district of every state of India.
Sample this: Some years back, the Union Ministry of Health and Family Welfare forced Sir Gangaram Hospital, a premier hospital in New Delhi, to offer the liver of a deceased person to a high-profile Hyderabad patient in need of a liver transplant, bypassing the need of another but less influential patient on the waiting list who needed it equally urgently.
A former pharmaceutical sales executive left the industry because he was expected to fly a doctor to Thailand and provide him with prostitutes at his home.
This is no minor allegation, and narrating this incident from 2010-11 is none other than Vinay Kumaran, a liver transplant expert who worked at the hospital at that time.
"Healers or Predators: Healthcare Corruption in India," is full of such incidents of glaring malpractices and corruption, and covers not just India but other South Asian countries as well. It has a fascinating forward by Nobel Laureate Amartya Sen.
The 656-page anthology, edited by two of India's top doctors, Sanjay Nagral and Samiran Nundy, and a former Union Health Secretary Keshav Desiraju, also includes articles by Sumit Ray; Kunal Saha; Soumendra Saho; Binayak Sen; Amit Sengupta; Arghya Sengupta; Abhay Shukla; S. Srinivasan; Sandhya Srinivasan; Avinash Supe; Shershah Syed; George Thomas; Farokh Erach Udwadia; M.S. Valiathan; Nisha Vinayak; and Shiv Vishvanathan.
India's medical community was jolted in 2014 with a major hard-hitting piece by David Berger in the British Medical Journal (BMJ) that described firsthand experience of how kickbacks and bribes "oil every part of the country’s healthcare machinery."
He had asked other influential countries to take punitive measures against Indian institutions fostering this kind of environment where such corruption was made possible.
On a debate on NDTV 24x7, Dr. Samiran Nundy narrated how a top Indian doctor objected when told that 90% of India's doctors were corrupt. He insisted that true figure is 99%.
Speaking about the corroded doctor-patient relationship in India, Berger had said, "Corruption is rife at all levels, from the richest to the poorest."
India's healthcare system is based in an inbuilt inequity: it is one of the most privatised in the world. Indian's spend more on health from their own pocket than Americans in the United States, percentage-wise.
With the government virtually abandoning the healthcare sector and leaving people at the mercy of the predator doctors, a majority of Indians have little or no access to healthcare.
Berger had said in terms as bold as these: "The country’s doctors and medical institutions live in an "unvirtuous circle” of referral and kickback that poisons their integrity and destroys any chance of a trusting relationship with their patients." (BMJ 2014;348:g3169)
The book reiterates many of the points headlined by the BMJ, including the widespread corruption in the pharmaceutical industry and doctors being bribed to prescribe specific drugs. Dr Berger had narrated the story of a former pharmaceutical sales executive who left the industry because he was expected to fly a doctor to Thailand and provide him with prostitutes at his home.
India's medical community was jolted in 2014 with a major hard-hitting article in the British Medical Journal (BMJ) that described firsthand experience of how kickbacks and bribes "oil every part of the country’s healthcare machinery."
One of the book's authors, Keshav Desirajus, is a former health secretary of India who was removed on the day India was declared polio-free, just because he opposed a move to reappoint Ketan Desai, a disgraced bribe taker, to the reconstituted Medical Council of India.
Most readers will find their own experiences reflected in the incidents and narratives punctuating the book — from exorbitant billing by corporate hospitals to the non-merit-based selection in medical colleges to the questionable motives playing strong in the area of organ transplantation.
While Dr Samiran Nundy is an Emeritus Consultant at Sir Ganga Ram Hospital, Delhi, Keshav Desiraju is chairman of the Population Foundation of India. The volume has been edited by Dr Sanjay Nagral, Consultant Surgeon, Jaslok Hospital and the publisher of the Indian Journal of Medical Ethics.
Some of the narratives in the book will make your blood boil. Among them is a chapter on ethical issues in organ transplantation wherein Vinay Kumaran describes how doctors treat end-stage liver patients as "geese” that can lay the "golden eggs.”
Such patients are sure to need frequent hospitalization, offering the possibility of maximum extraction of money.
Dr Nundy described the book as a dispassionate account of everything that is wrong with healthcare in India. Sumit Ray explains how the private hospitals aim is not better healthcare delivery but higher revenue generation. It is with this in mind that these hospitals have developed a financial model of employing ‘star’ physicians and surgeons at very high salaries.
Since the clientele-magnets are star doctors, the junior doctors, nurses, technicians and other staff are poorly paid. The ‘star’ doctors' increments, incentives, or even jobs are connected to targets.
These billboard names attract clientele with deep pockets. The rich are looted much more than the poor, in terms of absolute money.
Since the clientele-magnets are these star names, the junior doctors, nurses, technicians and other staff are poorly paid. The ‘star’ doctors' increments, incentives, or even jobs are connected to targets.
The book is expected to trigger a debate about malpractices and corruption in healthcare in India.
At an event in Delhi where the book was launched, former Union minister Salman Khurshid said laws to deal with corruption in the medical field are "illusory". Dr Berger, who was also present, said many doctors are morally strong but they become corrupt "because of the corrupt environment in which they function,"
Amartya Sen said India was heading into "a comprehensive healthcare crisis" and pleaded for allocating a larger percentage of gross domestic product on public healthcare.
"Despite being one of the fastest growing economies in the world, India ranks among the poorest achievers of good health," Sen said in his foreword.
Castigating the media for its poor focus on healthcare domain, Sen says: "If India's bad record in healthcare is not much discussed in the Indian press, this neglect does not indicate the presence of a tolerable level of healthcare in India, but reflects instead the narrow reach of the Indian news media, with its traditional neglect of elementary education and healthcare."
Sen speaks of "the amazing neglect of primary healthcare," the "premature reliance on private healthcare" and the lack of "informed public discussion on healthcare" in India.
The utter human apathy of us Indians is clearly visible as one watches patients from around the country, including some who have travelled for days, queueing outside India’s biggest public teaching hospital, the All India Institute of Medical Sciences (AIIMS) in New Delhi.
Despite being one of the fastest growing economies in the world, India ranks among the poorest achievers of good health.
As hundreds jostle to see erratically available specialists, and one can see scores of people crowding the roadside medical shops to purchase not just bandages and surgical equipment but even life-saving drugs, the scene does not change at night when you can find dozens of patients and their relatives sleeping under the bright lights of the closest bus shelters.
A few hundred metres away are New Delhi’s swank corporate hospitals where you can browse through the latest issue of Cosmo or Vogue, assured that your uncle is in the hands of best doctors who may be looters but have the skills.
If you can live with both these images, this book 'Healers or Predators?" may not do much for you. But if you are worried about whether your children will inherit a country with people who have decency, this may be the volume you have been waiting for.
Please watch this television debate on the state of healthcare in India and Punjab.
The author teaches mass communication and has interests encompassing journalism, and the intersection of politics and society. She is a frequent contributor to Punjab Today.