<link rel="stylesheet" href="//fonts.googleapis.com/css?family=Open+Sans%3A400italic%2C700italic%2C400%2C700">Health Archives « Aam JanataSkip to content

  • No more crying in the middle of the night 
  • No more playing in the middle of the street
  • No more mischief in the class
  • No more tantrums in the house 
  • No more exams to pass 
  • No more dreams to chase 

How can they, when the children are no more?

Not one, not two, 13 children died yesterday, 309 died in August alone, 1269 this year and all in the BRD government medical college, Gorakhpur, Uttarpradesh. 

This is not just because of a doctors negligence or an equipment failure or a random incident of negligence but a deliberate failure of an entire system. A system that was meant to diagnose, treat and cure, was left to decay so much that the rot just became toxic claiming innocent lives.

The CAG report published in August 2017 for the period beginning from 2011 ending 2016 March, exposes the rotten system of the BRD medical college. From failing to treat cancer patients to failing to conduct prenetal diagnosis to misusing funds to shortage of medical equipments - the medical college broke rule of law and violated the moral code of conduct. 

Excerpts from the CAG report 

✓ the GMCs failed to provide adequate treatment to cancer/heart patients as equipment such as Cobalt Teletherapy, Brachytherapy unit, Left Ventricular Assist Device, etc. were not being operated in hospitals due to lack of doctors/technical personnel/infrastructure.

✓ The GMCs did not execute Annual Maintenance Contract for equipment. As a result, the machines were not functional and tests for cervix cancer, foetal monitoring, prenatal diagnosis, bio-chemical and hormonal tests etc. could not be conducted.

✓ GMCs did not procure clinical and teaching equipment though adequate funds were provided by the Government, resulting in shortages of equipment

✓ The GMCs failed to provide adequate treatment to cancer/heart patients as equipment such as Cobalt Teletherapy, Brachytherapy unit, Left Ventricular Assist Device, etc. were not being operated in hospitals due to lack of doctors/technical personnel/infrastructure.

✓ The GMCs did not execute Annual Maintenance Contract for equipment. As a result, the machines were not functional and tests for cervix cancer, foetal monitoring, prenatal diagnosis, bio-chemical and hormonal tests etc. could not be conducted.

✓ GMCs violated the provisions of General Financial Rules while procuring equipment by extending undue favour to suppliers and purchasing equipment at a higher rate

✓ Financial management of the GMCs was not adequate as there were instances of retention funds for long periods in PLA, diversion of funds, etc

So what's next?
I'm sure the CAG report will have no affected on the administration because if a child's death didn't, then what's a report? And neither did it have any affect on the media, because the deaths continue to happen but not the coverage and further questioning. This leaves, us i.e you and me. So let's begin with questioning the authorities 

  • File an RTI with the BRD medical college to understand what steps they have taken for cours e correction. And if they haven't, then when would they?
  • Call the MLA's and the MP's and put pressure on them to not just fix the current problems but to elevate the standards of healthcare 

If we don't think we can do this, then just remember the faces of the kids who died or should we say, we let them die 

6

Contrary to the belief that the ever increasing attacks on doctors in India are isolated, much has to do with the deteriorating situation of law & order, crumbling public health infrastructure and evangelization of vigilantes.

According to the Indian Medical Association, 75% of doctors in India have faced violence. Although we don’t have any data for Maharashtra, from my experience, I could say almost every resident doctor in a Government hospital has either been abused or manhandled. The attacks are so frequent and intense, that BMC hospitals in Mumbai had hired a private security firm, Eagle Security a year ago. This security is apart from the police units stationed 24×7. And still doctors are facing some of the worst attacks. Previous UPA Gov’t passed Maharashtra Medicare Services Persons and Medicare Service Institution (Prevention of Violence and Damage or Loss to Property) in 2010. This law has been poorly implemented as the data speaks for itself. Even after constant assaults, not a single person was convicted in the last 2 years. Even though the imprisonment extends upto 3 years and the offence is non-bailable, the alleged attackers are bailed out within a day as it happened in Sion hospital after a Polio inflicted doctor was attacked 5 days ago.

The Cause

India spends only 1.4% of GDP on healthcare compared to 8.3% in US and 7.6% in UK. Even many African countries spend more on healthcare than India. As per World Health Statistics 2015, India’s per capita government expenditure on health in 2012 was a meagre $60, while the US spent $4,153. Central, State Governments and Municipal Corporations have evaded investing in healthcare for decades which has compounded the worsening of the situation. To make matters worse, Fadnavis led Government has actually reduced the health budget allocation for 2017-18 by ₹569 crores. The health budget of 2016-17 was in turn ₹1,308 crore less than in 2015-16. Maharashtra will also spend ₹900 crores less on nutrition schemes. Many ministers and spokesperson have repeatedly assured about increment in health budget, bu the reality is quite different. Public hospitals are constantly hit by shortage of medicines and staff. Patients being told to buy even IV and inhalational drugs in the casualty is a common sight, which obviously angers them. Resident doctors are at the front end of an inefficient, unjust and poorly funded public healthcare system.

IMA survey says 70% of attacks are due to relatives accompanying patients. Dozens of relatives, of which half are drunk accompany a patient in the casualty late at night. Even after constant complaints to the administration, this issue is never sorted out. Be it Dhule or Sion incident, every major assault was carried out by scores of relatives. On paper, only 1 relative is issued a visitor pass to be with the patient. As every other rule, this one lies in the dustbin too. One can’t expect a doctor to work properly who is under the constant threat of an assault. One can’t expect a surgeon to have a steady hand when he is perspiring due to fear.

Dilapidated infrastructure and horrible planning is the cornerstone of every Government project which is 10 times amplified in a public hospital. The X-ray room is situated almost 500 metres away from the casualty. There is always a shortage of wheelchairs and trolleys due to which, again, the junior doctors have to face the brunt, as they are the only ones present there. MRI, USG, CT scan appointments have a waiting period of months. Apart from the well-equipped trauma ward, every other ward has an issue. The resident doctors and interns do the job of class 4 employees due to lack of staff for tracing medical reports, carrying blood from blood bank, shifting patients to other ward. Many a times, I have personally trolleyed the patient to USG and X-ray. There is no clear distribution of duties among staff. Public frustration of this chaos is unleashed on doctors as we are the only ones they could identify.

Normally, only 2 or 3 resident doctors are present in the casualty at night. They are bound to provide only emergency care and diagnostics. Full treatment can only be issued after consulting with senior doctors. This process takes time which agitates patients. There is no counsellor to talk to patient. As the resident doctor has to take history, write notes, examine and provide emergency care; the not so important talking part takes the back seat. A faulty system like this, promotes more attacks on doctors. Not to mention, a resident doctor in a public hospital is overburdened. He/she normally works 14-18 hours a day with at least one 36 hours continuous shift once a week. In towns, such 36 hours shift is almost on every alternate day. Even a basic function like sleep becomes a privilege.

To avoid long queues in OPD, many patients come directly to casualty for instant treatment. Doctors can easily differentiate patients requiring an emergency or an elective care. Indian patients don’t accept oral drugs as they always expect IV drugs in a casualty. This delays the treatment of those who require urgent care. Most of them sit at home and visit the doctor only when the disease takes a severe turn. Diabetes Mellitus and Hypertension can be easily managed by drugs, but due to non-compliance, patients come with severe complications requiring surgeries. OPDs managed by 6-8 doctors have 300-400 patients on a daily basis. Sion hospital itself caters to 20 lakh OPD patients annually. Despite all this, the Government isn’t interested in increasing the number of hospitals. Only 1 out of every 20 MBBS graduate gets a PG seat.

There is no fear of law among mobs assaulting healthcare professionals. Relatives of the arrested Dhule assaulters tried attacking a nursing staff outside the campus. A doctor in Sion hospital threatened of the same consequence of Dhule doctor if the patient doesn’t get well. A rural hospital ransacked in Sangli for an alleged delay in post-mortem. A casualty officer in Bhabha hospital, Bandra slapped. All within the past 24 hours, during the ongoing strike!

The Demand

Residents doctors are fed up with constant fake assurances and lack of proper implementation of current laws. Gov't keeps on repeating the same promises with a different date. The main demand revolves around providing improved security and limiting entry of relatives.

  • Appointment of more security and police personnel immediately
  • 2 pass system per patient
  • To start the installation work of effective alarm system in every casualty
  • To revoke all charges and action taken against resident doctors
  • Strengthening of 2010 law, no bail for accused for at least 3 months
  • Filing of FIR by the institution itself
  • To release funds to implement the law and appoint a brand ambassador to spread awareness for the safety and security of doctors
  • To enact a strict law to prevent trespassing in hospital
  • Formation of a vigilance team within 15 days
  • Formation of a legal cell withing 15 days

An Ortho resident doctor in Dhule was attacked on 12th March while the statewide strike started on 20th March. The violence was so brutal, that he had an orbital fracture and is feared to lose vision in his left eye permanently. The state Government remained dead silent for a week. In fact, doctors and interns in GMC, Dhule were threatened of dire consequences if they go on a leave. Fearing political pressure, the leave was called off in Dhule. On 18th March, after a helpless junior doctor was attacked in Sion hospital, 4,000 resident doctors decided enough is enough. Even after multiple meetings with Medical Education Minister, Girish Mahajan and Chief Minister, Devendra Fadnavis, there is no visible improvement in the security as of now.

To make matters worse, CJ Manjula Chellur of Bombay High court said, “If doctors are so afraid that you will be assaulted then resign and sit at home. It is a shame on the profession if doctors go on strike like factory men. They are unfit to be doctors then.” This statement seeks of victim blaming, elitism and promotes violence against doctors. It’s a moral equivalent of saying, if women are afraid of rape then they should sit at home. Judiciary, Media and the Government are busy blaming doctors for everything that is wrong with our healthcare system.

The Present Status

As of now, the resident doctors of KEM, Sion, JJ, Solapur and Latur Government hospitals have got eviction notices and suspension of their degrees. According to resident doctors, water supply in PG hostel of KEM and Sion hospital was cut-off. MARD (Maharashtra Association of Resident Doctors) has colluded with Girish Mahajan in breaking the unity of doctors by giving out fake statement of mass leave being called off. An utterly despicable tactic which is the hallmark of the current political discourse in the country. Media has played a disgusting role by siding with the Establishment and parroting their lies. No one is questioning the Gov't for their repeated fake assurances and rehashing their old promises with a different date. No primetime discussions on the dwindling health budget. Even when doctors join their duty again, this faulty health system will still persist.

Individual doctors of public hospitals and not MARD are involved in this protest. Although there is no official confirmation yet, MARD chapter in Mumbai has been dissolved. On 23rd March, more than 40,000 doctors of IMA & IDA joined in an indefinite strike by shutting down all OPD and elective services pan-Maharashtra. Dentists, interns, teaching staff, senior doctors, paramedical staff, nursing unions, class 4 employees in public hospitals are supporting this resistance. Medical Teachers Association has threatened mass resignations if security isn't improved within 48 hours. Over 10,000 doctors in 40 major hospitals except AIIMS, have gone on a mass casual leave in Delhi. Barring pseudo-scientific doctors union, everyone else is echoing #IssBaarAarYaPaar. As I write this article, a new union consisting of resident doctors, private practitioners, IMA members, lecturers, professors, SMOs, DNB doctors, ex-MARD members is being formed.

The emergency services in both private and public hospitals are still working due to senior doctors, nursing staff and interns. The healthcare system is affected, but we have tried our best to reduce the impact. IMA and resident doctors will evaluate about the leave after they get a written court order. Judiciary, netas, celebrities all get private security. All we ask for is improving safety in public hospitals.

The resistance continues.

2

As of August 4, 2014, selling food on the street will be a criminal activity. Say goodbye to your favourite panipuri wala, sandwich wala, frankies stand and every other kind of street food vendor. Also bid farewell to small establishments like the neighbourhood mithaiwala, street-corner bakery, doodhwala, lassiwala, kulfi-wala and roadside butcher-shops-cum-kabab-joints. You should worry even if you are one of those enterprising housewives selling homemade chocolates, cupcakes, marzipan bunnies and Easter eggs to your friends and neighbours in the festive seasons.

In the popular serial Taarak Mehta Ka Ulta Chasma, Madhavi Bhide — the typical middle-class housewife — supplements her penny-pinching husband’s income by supplying papads and pickles. Well, now Madhavi faces a choice: either take a license by paying a fee of Rs 2000/-, or face imprisonment of upto six months or penalty of upto Rs 5 lakhs, under Section 63 of the Food Safety and Standards Act 2006.

Read this notification: http://tinyurl.com/FSSAI-4-Aug-Deadline

Also read the highlighted paragraphs in (a) Food Safety Act 2006 and (b) Food Safety (Licensing) Regulations 2011. Download from http://tinyurl.com/Food-Act-Regulations

But a licence is only the beginning. The vendor must meet FSSAI’s high standards. This could mean serious money in modifying facilities, or else shut down. Failure to comply could be fined lakhs of rupees, or even imprisonment for six months. This setup is ripe for a thriving business in bribery. Needless to say, the expenses in being compatible with the law - both officially and unofficially will be recovered from the customer, which basically means more expensive street food.

Food Safety Standards Authority of India has notified August 4, 2014 as the deadline for getting registration and license with Food Safety and Standards Authority. We can hope that this deadline will be postponed as it has been since August 2012, the original deadline. But the sword will continue to hang over our heads… unless, of course, the new government elected at the Centre furiously back-pedals.

NOT JUST COOKS, BUT ALSO TRANSPORTERS AND SELLERS

The dabba-walla who transports a home-cooked lunch to your office is a transporter and handler of food, and a Food Business Operator as defined under the Food Safety (Licencing) Regulations 2011. Needless to say, most dabbawalas cannot possibly meet FSSAI’s hygienic standards - which presumably won't allow tiffins on the floor of dusty luggage compartments on local trains - even though the tiffin itself remains unopened and has been successfully going through this system for decades without health issues.

Your neighbourhood kirana-store, who sells grains, spices, nuts, oil, biscuits etc. is also in jeopardy. Unless he invests lakhs or crores of rupees for upgrading his shop with air-conditioners, glass doors, freshly painted ceilings and marble floors etc, he may not be given a license to sell food items. Then he cannot sell so much as a toffee or a bottle of packaged water.

This is the brave new world envisioned by Government of India. The road to hell is paved with good intentions. Bubbling with good intentions, the Food Safety and Standards (Licensing and Registration of Food Businesses) Regulations 2011, are a nationwide disaster-in-the-making. It is about to hit the common man right where it hurts most. Wham! Right in his wallet!

Indeed, the conditions imposed on storage, preparation and handling of foods are so stringent that a majority of household kitchens and office canteens would not make the cut.

BIG BUSINESS IS THE GAINER

Who can possibly meet the impossibly high standards of food preparation and storage set by dozens of scientists at FSSAI? The likes of McDonalds and Pizza Hut may have no difficulties, and ditto for Pepsi, Coke, Haldirams and Britannia. Also, big retail outlets like D-Mart and Big Bazaar.

But small outfits will have no option but to close down, or to operate on the fringes as criminal offenders and fugitives. The current dispensation has given a death sentence to the entire unorganized food sector spread all over the country — consisting of many million self-employed men and women living in various cities, towns and even the remotest villages. In tiny settlements on snowy mountain-tops, or in the midst of forests and deserts, entire families and communities work together to survive by selling various food products to travelers and pilgrims. This vibrant food service industry of India is now marked for slaughter. One wonders why.

A vast expanse of potential criminals waiting for discovery by any cop walking down the street and Shangri La for the greedy who deal in law enforced to taste for profit.

FLYING UNDER THE RADAR

How did this horrific thing come to pass? How did such a far-reaching legislation slip unnoticed, like a jumbo jet flying under the radar? One explanation is: it happened because the Food Safety Act 2006 and the lengthy licensing regulations seemed like a good thing at first.

Food was earlier regulated under various orders passed by the union government, such as Prevention of Food Adulteration Act 1954, Fruit Products Order 1955, Meat Products Order 1973, and Milk & Milk Product Order 1992. Some people in the food industry actively lobbied for all these orders to be unified, so that implementation would be easier. However, the unification exercise was taken up with so much zeal by bureaucrats that it led to a kind of bureaucratic overreach. In the words of Gokul Patnaik (098100 63433), a retired IAS officer who was formerly chairman of APEDA (Agricultural and Processed Food Products Export Development Authority) is among those who lobbied for such a unification. And now, on hindsight, he regrets the outcome. “We seem to have created a Frankenstein’s monster, whose appetite for controlling our lives seems endless,” he remarks.

Indeed, if you casually browse through Food Safety Act and Regulations with a common man’s eye, it seems like a well-intentioned (if over-ambitious) effort to improve the quality of the food that all of us – both rich and poor – eat and drink. The standards imposed on the licensees are formulated by committees peopled by well-known scientists from all over the country. These standards are aimed at reducing pesticides, enzymes, antibiotics, harmful bacteria, and biological contaminants like hair. Who can possibly argue with that? How can anybody say that it is not a good thing for safeguarding public health?

Public consultations were also held in 2008, and trade bodies like FICCI and CII represented civil society. Hawkers and enterprising housewives were never aware of these consultations, and even if they were aware, would not have been able to put across their concerns in a way that the bureaucrats would understand.

Indeed, the impossibility of holding genuine stakeholder consultations becomes apparent when you consider the mind-boggling span of the term “Food Business Operator”. It climbs up the ladder of scale starting from the tiniest iterant chai-samosa vendors, temporary and permanent food stalls, home-based canteens and dabbawalas. It encompasses office and school canteens, langars in gurdwaras, distribution of various prasads in temples, religious gatherings and fairs, and wedding feasts. And at the top of the ladder are importers, packers, cold storages, warehouses, transporters, retailers, wholesalers, distributors and five star hotels.

Some traders’ associations and food manufacturers’ bodies opposed these regulations, but that too may have been written off as a knee-jerk reaction; after all, who among us says yes to more regulation? The remarks of Confederation of All India Traders (CAIT) can be found here here: http://www.cait.in/cait-articles.php (Article titled “Top Three Issues Under Food Safety Standard Act Faced by the Industry”)

The members of All India Food Processors Association (AIFPA) are on the central advisory committee, scientific panels and expert groups of Food Safety Authority. Dharam Vir Malhan (9868218848), Executive Secretary of AIFPA and formerly head of the Modern Foods, a government enterprise, is coordinating the participation of these members, who are deeply aware of the beneficial as well as adverse consequences of the proposed new licensing regime. “Going from feedback that I receive from food industry stakeholders at various levels, the new regulations are over-ambitious and at many places, highly impractical to implement,” Mr Malhan says mildly.

This is an understatement. The administrative burden at various levels is enormous and widespread. Registration under the Food Safety Act is to be done by local bodies i.e. municipalities and gram panchayats. The licensing mechanism is in state and centre, depending on the scale of the manufacturer. Large scale entities will require multiple licenses – one for each separate activity such as import, repacking, transportation etc., and one for each location of factories, warehouses, etc. The multiplicity of the paperwork required, and the massive reach and discretionary powers of the officials within the registration and licensing mechanisms is a sure-fire formula for both corruption and administrative overload.

According to its preamble, the Food Safety Act was conceptualized to consolidate the existing food laws; one presumes that the intention was to simplify, and not to complicate. Very clearly, this exercise has gone off track.

KILLING MICRO-ENTERPRISES & SELF-EMPLOYMENT AT BIRTH

The full menace of the regulations has clearly not been understood by civil society and activists; otherwise human rights crusaders would have been up in arms! Because even mild enforcement of these regulations will criminalize over 99 per cent of the non-packaged food sector in our country, rendering them liable for penalties of several lakhs of rupees and several months of imprisonment. If that is not a human rights outrage, then what is?

Such a formal business environment – where one is required to get a registration and license before selling his first plate of vada-pav – means that tiny food businesses may never come into existence… or may be seen as an unlawful enterprise from day one!

Let us take an example to understand how small businesses grow. Take the case of a neighbourhood auntie who prepares delicious parathas. One day, a group of young MBA students move into the neighbouring flat as paying guests. As a neighbourly gesture, the auntie sends them six parathas to go with their morning tea. The love the fresh hot parathas, and so they request the auntie to send them a dozen parathas every morning for their breakfast, and they voluntarily offer to pay Rs 5 per paratha. And then, word spreads among their friends, and the auntie, who used to cook only for herself and her family, now finds herself supplying parathas to several groups of paying guests in the neighbourhood. Voila, a food entrepreneur is born!

However, FSSAI’s regulations say that as soon as the students offer to pay for the parathas, the auntie has to apply for a license from FSSAI and pay Rs 2000 for a license. The Food Safety Officer may then come to her house and check her kitchen. He may deny her a license if her ceiling paint is peeling off, and while parting, warn her that if she continues to feed her neighbours, he can fine her Rs 5 lakh or drag her before a special court and get her imprisoned for six months! Behold, a food entrepreneur has been killed at birth!

CRIMINALIZING INNOVATORS

Indian cuisine is full of experimental products, and street foods are at the cutting edge of experimentation. For example, popular items like bread pakodas, Chinese Bhel, roti-rolls and kathi-rolls and novelty items like ice-cream pakodas have all sprung up in response to entrepreneurial inventiveness sustained by market demand. All Indian foods have been created in this way. An over-scientific approach to the process and formulation is toxic to innovation. So, it is alarming that FSSAI’s bloated bureaucratic set-up wants to not only control the cooking and storage environment, but also control the FORMULATION of each and every item, and confine it within documented parameters!

Under the new FSSAI regime, all known items are standardized and their formulations are written down. If someone wishes to make a new item – say an item like bread-pakoda using crushed banana wafers in the filling – then he must first submit this formulation to FSSAI and seek their approval for it – a process that typically takes two or three years. And the new regime makes producing such innovative foods and selling them without approval a punishable offense!

It is both audacious and ridiculous to even attempt an exercise of defining standards for every food in India. Because a “chutney” in every state, every district, every tehsil, every caste and community has very different ingredients and methods of preparation. A simple thing like a roti tastes very different in every household, and has varying amounts of ghee, salt, thickness, diameter etc. The same goes for hundreds of types of halwas made in temples, gurdwaras and sweetmeat shops. How can a centralized body of scientists and bureaucrats like FSSAI impose standards for such things? But that is precisely what it is doing!

Manufacturing apart, it is also an offense now to import and sell a novel food that is well accepted abroad but not currently being sold in India – such as, say, fresh strawberries encased in a hard chocolate cover. Importers will not be able to release their stocks into the markets unless FSSAI first tests and approves it for public consumption.

Gokul Patnaik remarks, “If this sort of pre-approval process were in force in olden days, the halwais could never have invented foods like rasgollas and jelebis. Innovations happen in the kitchen at the spur of the moment, and the only approval needed is from the tastebuds of customers willing to pay for them. For bureaucrats to insist that a gulab jamun must only have this much sugar and this much ghee – no more and no less – is to impose a bureaucratic approach on cooking itself! This can only result in killing innovation!”

IMPOSING INSPECTOR RAJ OVER FOOD

The FSSAI Act mandates Food Safety Commissioners in every state to appoint numerous government employees as Food Safety Officers, with powers to slap a closure notice on any Food Business Operator, and also slap penalties of upto one lakh on them for any offense defined under the Food Safety Act. In the name of safeguarding the health and well-being of India, this is a return to inspector-raj and rampant bribery, far worse than the pre-liberalization days.

India’s people have to raise their voice against this over-zealous bureaucracy, and the time is now.

Edited from a press release ISSUED IN PUBLIC INTEREST BY
Krishnaraj Rao
9821588114
Mumbai

Primary health care with skilled nursing facilities and medical technology for prenatal care and delivery. Possibly medical technology for a cesarean section and a neo natal intensive care unit. How complex can it be for the abilities of an upcoming superpower like India? Health care reform is an urgent need, yes, but what does it take to provide a clean and safe birthing environment? Even speaking of skilled nursing facilities, what terribly difficult skills are involved?

Mistry is a carpenter. He has worked with my husband for many years. Today, he arrived in a hurry to collect some money my husband had left for him. Thin, wiry man in his fifties with a cadence from rural Maharashtra, he claimed to be in a hurry and refused tea. Accepting a glass of water, he chatted with me for a short while as he took out a miniature cheap note pad and a "one rupee pen" (the plastic kind you get in trains) from his shirt pocket. Tucked in the spiral bound notebook was a carefully folded A8 size paper with numbers. Presumably accounts or information related with the job. Frowning in concentration, he noted something on the paper, carefully folded it and tucked it into that notepad and returned both note pad and pen to his shirt pocket, hooking the clip of the pen on the cloth so it won't fall off. Testing to make certain the pen was secure.

This is a working class man from an older generation. No flash and dazzle for him. Careful work. Attention to detail. Careful recording of hard earned money.

When I enquired after his family, he informed me that he needed the money for his daughter's hospitalization. Alarmed, I asked him what was wrong with her. There was nothing wrong. Her pregnancy due date was near. Mistry was to be a grandfather soon, and his wife had returned to her parent's home for her first delivery.

He said he had gone to the government primary health care center first, for prenatal care and to register for delivery. He was told to take her to a private maternity home for delivery because the government hospital didn't have skilled nursing facilities or medical technology - these were the two exact reasons given. Remarking wryly that in his time women had babies at home, he said he was collecting all his dues and taking advances where possible to have money ready. He did not want his daughter to suffer unnecessarily or face risks to her health or life as her pregnancy due date approached.


Community health in India

The people in the government hospital had recommended him to a private hospital telling him that she would be safer there. I was aware that this is likely a routine practice of getting paying customers by advertising to people approaching public health facilities. My mother had been recommended to another private nursing home a few years ago in the very first meeting when we had first started to get her help for schizophrenia. This is in spite of government hospitals boasting of "expert doctors" (who usually own private clinics).

I remarked that private hospitals are not necessarily better with medical care considering my experience with Nisarga's nightmare birth, where I was in the private maternity hospital that specialized in deliveries and was reputed to be the best in the area. Besides, delivery hardly takes any specialized medical technology in routine cases, and government hospitals with their surgical facilities and doctors on duty and neonatal wards would be far better in a crisis than a private maternity home, where doctors are usually absent till the baby starts crowning.

He agreed. Then paused and said that if it was this bad in a private hospital, the government one would be worse. His daughter may not be helped with pain management or the medical care may be lacking or his grandchild may suffer infections. Can't dispute that. Particularly the last. Hospitals are hot beds of neonatal infections in India. I have two friends with children who died within a day of birth from infections - ironically, both in highly competent medical facilities with the latest in everything, but this was clearly not the time to bring it up. And in any case, the government hospitals have no better records to go by news.

Besides, the government hospital near their home was not so big and it hadn't looked very hygienic when he went there. I cringed, knowing that this man is paying for private care he cannot afford, because the government facilities are there, yet not. For a moment I almost recommended a home birth which, in my opinion is probably the most healthy choice, particularly with a home healthcare provider, ideally a midwife or "dai" - check out infant mortality in hospitals), then stopped. It was a long reasoning and against the recommendations of what is best by the "medical profession" in which he had put his faith. If anything went wrong... This was not the time to throw him into indecision on the basis of my ideas, with the pregnancy due date within a week.

He left.

I am left with thoughts of how 65 years after independence, the government's healthcare system cannot assuredly handle something that has been happening naturally since the birth of mankind and usually happens spontaneously with very little "facilities". Nor can it monitor private facilities for something this basic. We have discarded ages and ages of wisdom in favor of a new system we cannot offer consistently. So the common man is literally left neither here nor there.

One has to wonder what exactly it is that the government means by healthcare. Or is it healthscare? A citizen has a right to free health care. A government hospital refering patients to private clinics because it doesn't offer basic medical facilities must ask the patient to submit the bill for reimbursement!

Problems drive an alcoholic to drink

Well... kind of true. Problems, achievements, company, lack of company, boredom.... all drive an alcoholic to drink. Problems drive an alcoholic to drink, yes, but so does everything else.

Alcoholics are only showing their true nature

This is not true. Alcoholism changes the perception of needs so that the need for alcohol is always urgent and more critical than the need for relationships, dignity or other objectives that drive social interactions. It is not "inner nature" to court damage to reputation for example - even for exploitative or self-destructive people, but it is a frequent sacrifice in the pursuit of alcohol. The laziest alcoholic will court a mile long walk to buy alcohol, for another example.

I write/paint/sing/whatever better after a peg or two // Alcohol makes me creative

What alcoholism does is lower inhibitions. It removes internal censors by the simple means of reducing the brain's capacity for complex thinking. It may seem like increased productivity if you have self image issues or other inhibitions preventing you from working freely, but it most certainly does not improve quality unless your standards are really low. The lowered inhibitions are as likely to let your creativity through as your lack of it.

I don't drink in the morning, so I am not an alcoholic // You turned me into an alcoholic

Alcoholism evolves. If people have raised concerns about your drinking, if you drink compulsively, if social occasions seem boring without drinks, if you avoid non-drinking company in your drinking timings, if being denied drinks makes you angry... then it is a matter of time.

A person's presence in another's life may coincide with an escalation in drinking, but one person cannot turn another into an alcoholic. Period. Such accusations by alcoholics are a way of shifting the burden of guilt. They should be ignored.

I drink from my own money // I know my limits

On running out of alcohol, the ownership or source of the money (or directly alcohol) are no longer issues. Limits get reviewed and approved extensions automatically. It does not matter where the money for the drink comes from, when it runs out, the price of alcoholism is paid by the home with emotional damage, physical damage, financial damage that goes well beyond the cost of the alcohol consumed. This could be anyone coming into intimate contact with the person if the alcoholic no longer lives with family.

I am really respected and loved by the people who work at XYZ Bar/Club/Liquor shop // They let me pay later if I don't have money

If you are known and regular enough for an establishment serving alcohol to be paying special attention to you, it is worth considering that you have become business they count on. This is not to say that there is no genuine affection and friendly relationship that grows, but it is extremely concerning when a person flaunts these relationships in front of other relationships. Many alcoholics also start nurturing their self-images that are damaged badly by alcoholism by seeing this as servitude and superiority, much like a ruler of the bar. This fantasy is profitable to waiters, because it invariably leads to magnanimous gestures and generous tips. A very definite warning sign for the person reduced to asserting self worth in this manner.

 

If you have used these explanations for yourself or someone else, know that the need for those explanations to be required in itself is a sign of alcoholism. No one asks a person who doesn't drink too much why they drink so much. At least not often. Requiring explanations for drinking, particularly when speaking with people who drink themselves, means those explanations are myths, unless they are "I drink, because I feel I cannot do without"