Book Excerpt: Battling Covid-19, With This Public Health System?

Excerpted from ‘The Gated Republic: India's Public Policy Failures and Private Solutions’, by Shankkar Aiyar, with permission from HarperCollins.

Delhi, April 2018. The Sushruta Trauma Centre, a Delhi government hospital. Patient Vijendra is admitted with a head injury. The surgeon, instead, drills a hole in his leg and inserts a pin. Vijendra is anaesthetized and so he can’t point to the obvious, that his leg is perfectly fine. Later, it is discovered that the hospital confused Vijendra for another patient, Virendra, whose leg needed the surgery. It continues to remain a horrifying mystery how a doctor and his entire team in an operation theatre could not see with their own experienced eyes that Vijendra had a head injury and two healthy legs.

Jhansi, March 2018. A twenty-five-year-old bus conductor, Ghanshyam, meets with a serious accident. His left leg is crushed and amputated. He is rushed to the Maharani Laxmibai Medical College Hospital in Jhansi and his family runs helter-skelter in search of a specialist. Ghanshyam’s images go viral on social media and therefore make it to the national news. Why? Someone had placed his amputated leg under his head as a pillow. Worse, the hospital staff wouldn’t move it despite his family’s pleas. Nobody knows who placed the leg there. Ghanshyam was unconscious; the CCTV, meant to enhance accountability, was not working. Thus, the enquiry that followed would not serve too well in discovering the truth.

Vadodara, March 2018. A young mother undergoes a caesarian section delivery at the government-run Jamnabai General Hospital. She is discharged after two days. A few weeks later, the woman finds herself in acute pain and starts vomiting frequently. She is taken to Delhi’s Sir Ganga Ram Hospital. Several rounds of tests reveal that during the C-section, doctors had left gauze bundles in her abdomen.

Unnao, December 2017. The primary health centre at Nawabganj suffers from frequent power outages, as do many hospitals across the country, but on that Monday, the power shuts down even earlier. There is power back-up but there is no diesel to jump-start this facility. The doctors operate on thirty-two patients for cataract using two torches. Incidentally, this centre has only five beds.

Bilaspur, Chhattisgarh, November 2014. A group of women agree to undergo tubectomy, persuaded by incentives. The operating area where tubectomy was conducted was not sterilized and the staff reused syringes and needles. In less than five hours, eighty-three women were operated on. With no infection-control protocols in place, thirteen of them died and forty-nine had to be hospitalized. In February 2017, the doctor responsible was acquitted on technical grounds.

There was a time when such cases of medical callousness were expected only from India’s BIMARU states: Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh.

In June 2017, a Delhi family mourned the death of its baby twice in two days. The baby was born twenty weeks premature and declared dead on delivery at Safdarjung Hospital. The family, while taking the baby for its funeral, found its frail body moving. They rushed the baby back to Safdarjung Hospital, where it battled for life for thirty-five hours on a ventilator, after which the same hospital declared the same baby dead for the second time. The father, Rohit Tandon, asked, ‘How can doctors not know the difference between dead and alive?’ The health ministry ordered an inquiry.

The consequence of uncaring state-run healthcare systems is reflected in the empirical data on India’s ranking across health parameters. In 1990, three decades ago, infant mortality claimed eighty-nine of 1,000 children, and India ranked 156 among 194 countries. In 2017, India was still at the bottom quartile, ranked 143 with thirty-two deaths per 1,000 births, trailing Namibia, Dominica, Botswana, Tajikistan and even Rwanda. In South Asia, barring Pakistan, India trails Sri Lanka, Bhutan, Bangladesh and Nepal.

In August 2017, in just twenty-four hours, twenty-three infants died in Gorakhpur’s Baba Raghav Das Medical College Hospital. In a five-day period, over seventy infants admitted to the hospital’s neo-natal ward for treatment of Japanese encephalitis died due to lack of oxygen supply. The hospital did not have the required number of oxygen cylinders because the oxygen supplier had not been paid his dues.

Gorakhpur sounds far-flung, but the national capital does not. In September 2016, at the Jag Pravesh Chandra Hospital, a baby died because she was denied ventilator support. The baby was born with birth asphyxia and the doctors asked the family to make it breathe with an ambu bag, a primitive method. The poor parents, not being able to afford private hospitals, went to three other government hospitals but were turned away as beds were not available. Just a month earlier, in August 2016, the health ministry, in response to the number of deaths of children in central government hospitals, had assured Parliament, ‘All the ventilators and others equipment procured during the said period are functional in these hospitals.’

India is in the company of low-income sub-Saharan countries when it comes to quality of healthcare.

Shankkar Aiyar, political-economy analyst, is the author of ‘The Gated Republic –India’s Public Policy Failures and Private Solutions’, ‘Aadhaar: A Biometric History of India’s 12-Digit Revolution’; and ‘Accidental India’.

The views expressed here are those of the author and do not necessarily represent the views of BloombergQuint or its editorial team.