The Great Indian Public Hospital
Fond memories from a place of misery
My association with India’s massive government hospital system began in 2004 when I entered medical college as a first-year student. I was at Pune’s B.J. Govt Medical College, and had yet to fully realize what was in store for me at the college and especially the attached Sassoon General Hospital (a behemoth institution established in the 1860s). Over the 5 and half years of my MBBS time there, and later as medical officer there and other government hospitals, I learned a tremendous amount about so many things. A few years into practice, I wrote a short blog post in honor of the life lessons that one receives as a practitioner in any of the several big urban public hospitals in India. I am reproducing that old post here, supplemented with annotated photographs.
In one corner of a huge, dimly-lit casualty room (or emergency room, ER) of a public hospital in India, a young doctor is struggling in perhaps the most miserable conversation of her life; communicating the death of a patient to their loved ones is, after all, a ‘skill’ doctors take time to ace. Loud whining and crying have erupted from the adjacent room — the seasoned doctor there seems to have finally sailed through the rough talk. Outside the ER is a mob of dozens of people, discussing animatedly the fragile health of a friend who’s being treated. The security guards are on their toes, their discussion about when the authorities will end the three months’ salary-drought having been interrupted by the CMO (Chief Medical Officer) asking them to watch the crowd.
An ambulance enters screechingly and who looks like a pizza delivery person is rushed inside on a stretcher with a huge wound on his head bleeding profusely. His arrival makes a surgical intern visibly excited, as he had been waiting the whole day to ‘practice suturing’. His senior is quick to chastise him though: Our profession sure is kind of perverse in relying upon people’s misfortunes to keep it going, but you don’t need to go about brandishing the fact for everyone to see. So perverse in fact is this ‘noble profession’ that one doctor’s antibiotic is another’s pathogen: for on seeing the head injury patient the surgical resident braces herself for yet another sleepless night in the Operation Theater. Suddenly loud noises emanate from the main cabin: the CMO has apparently lost his cool over a patient who subtly offered him a bribe in exchange for a false, favourable injury report. The nurses promptly start buzzing; they know there is another CMO (Dr X) for whom such offers are like manna from heaven. Rumour says that Dr X has just one work agenda: Don’t call it a day until the bulge in the pocket parallels the bulge of the paunch.
Meanwhile, in the labour room on the upper floor, three doctors are flattening the bulges in their pockets and pooling together money to help their patient, a restaurant waiter, buy the two units of blood his in-labour wife urgently needs. In one OPD a doctor is inconsiderately berating a patient for not ‘seeing straight ahead’ during an eye exam; while in the ward downstairs a doctor is waving away the copious thankful gestures of her patient by humbly saying ‘we are what we are only because of you.’
These highly unique and powerful scenes are a daily occurrence in a government hospital in India. If it were ever possible for all the emotions of all the people in the hospital to collectively float above and form a cloud, that cloud on condensing would rain ecstasy and hope, and despair and melancholia, and everything in between, all at once.
The public hospital is one of the most significant addresses in the lives of most Indians. And just like the country itself, it is a place of glorious contradictions. When a poor Indian needs the cheapest medical help, it is the place to go; when a rich Indian wants the best medical education, it again is the place to go. For an optimist it is a venerable temple: despite so much despair and frustration in the sterile air, hope and kindness always spring up from some or the other quarter. The camaraderie between neighbouring patients and their kin is legendary. If there were a ‘best ice breaker’ contest, ailments would be the most impressive competitors of weather: in the hospital, inquiries of ‘so what brings you here’ between strangers snowball into riveting discussions on family matters etc. within minutes. Patient kin are quite a significant volunteer force in any Indian public hospital, helping the medics and paramedics in everything from holding the arm of a patient during a blood draw, to fetching food and medicines for patients whose kin are absent or away.
Doctors in India are being much maligned of late for a lot of legitimate reasons, but that is just one side of the coin. Here you will see many young docs huffing, puffing and drenching themselves in sweat to save someone’s life, or defying sleep heroically so as not to miss a single change on the monitor of an ICU patient, or relinquishing festivals, parties and family get-togethers so that there’s always somebody at the hospital to look after the patients.
Just like that other eternal symbol of Indian society and culture, the Indian Railways, the public hospital too provides wonderful insights into the psyche of this electrifying nation. And despite the hundreds of glitches due to the peculiar nature and functioning of India’s govt organizations, both these entities have been going strong and running fairly satisfactorily due to the passion and zeal of their unsung, anonymous ordinary employees. The hospital also serves as one of the best examples of The Show Must Go On attitude. While in some room someone breathes their last despite health workers’ best endeavours, another room sees their efforts help someone take their first breath. As if the countless incarnations of Disease were not enough, this unremitting contest between Life and Death intimidates the hospital all the time; but with the gallant characters of coated, gowned, scrubbed, gloved and masked workers inspiring it, the Great Indian Hospital marches forth day and night, unperturbed.
[I wrote this originally, as far as I remember, in 2013. I have learned a lot more about Indian healthcare and the medical profession since then, and I hope that some time in the future I’ll once again spend time in a public hospital, to look at it with new, more mature eyes.]
SOME VINTAGE PICS FROM THIS EXTRAORDINARY WORLD
