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Tuesday, August 25, 2015

Not on a jovial note!: How to make public health sector more credible?

Tuesday, August 25, 2015
Not on a jovial note!: How to make public health sector more credible?: The public  health care system in India suffers a serious lack of credibility. Part of it is a true reflection of the status that the system really is but a larger contribution is by the orchestrated denigrating campaign by the media, aided by the private sector for obvious reasons and the governments itself.
Any body who knows the working of a hospital knows for sure that the backbone of the services is the junior doctors who with long interminable duty hours, very trying living conditions and being at the rough end of the butt every single moment both at the hands of seniors and public, put up a gallant show to cope up with the sea of work volume. The best quality junior doctors are available in government run medical colleges. In many so called big hospitals who run the show especially in the night hours? The BAMS and DHMS* degree holders who have absolutely no training in critical care and whose reflex reaction is to silence an alarm when a monitor beeps! Yet, they score so heavily over the private sector. Why? The reasons are not difficult to comprehend.
The infrastructure and equipments are not the issue, but these do not make a system humane.The relatives of patients largely equate their comforts to the quality of health care, which it certainly is not. This brings us to the basic issue of a good house keeping. The unusable, dirty wash rooms and the floors, the over infestation by cockroaches and the worn out sewage and water supply systems, many a times a leak in to water supply with ever looming large dangers of hepatitis, enteric fever and the breeding heavens of mosquito with ever readiness to inflict dengue and malarial bites do not inspire confidence. The solution is to allocate more funds for house keeping and ensuring that the aliquot goes to the area for which it is earmarked. The surfeit of investment in CT scans and MRIs is disproportionate to their small needs, if I complain about it people will through up their arms and engage in a debate of either/or situation. Certainly we need both, but we need to prioritize! Clean drinking water or Mars mission? We can have our pick!
The bigger challenge which costs nothing is the communication! The total lack of empathy, the demigod status of doctors( Partly accorded by the patients in times of needs), " I know all what is best for you" attitude, the condescending mannerism all add up to the pathetic state! We are never taught horning our communicating skills in medical school! The lack of communication is matched by the want of skills! There is a huge gulf in this area in the developed and developing world. Can this all be linked to lack of premium on life, is it a function of exploding population and the huge work load that it generates, is it related to non influential, have nots  people coming to public health which the health providers do not see of any material use to them in advancing their career, is the malady deeper than what meets the eyes? Could a proper referral system help matter? People thronging medical schools for trivial ailments have a telling effect on the dispositions of already over worked people, their skills not used properly and energy drained in trivialities? Could a different outdoor system to streamline the crowd be helpful, could preventive health delivery be some how conjugated with treatment part? It is here that the glib talkers, people promising moon score over, the patient wants to hear, " Do not worry I am here", instead he gets, " Nothing more can be done, we are doing what is possible"
A common man believes and not without reasons that he will not be given a patient hearing and the public hospitals are only meant for people who are influential and who have approach. The person in the lowest financial rung of society does not want to go to these hospitals even when managing 2 square meals is a huge task for him.
And the role of the governments? The officials, politicians and the ministers dole out a step mother treatment to their own health sector. In my place all these people do not waste a  single minute to shift the patients from government hospitals to private ones of their choices, what signals does it send to society? I think nothing dents and erodes the credibility of public sector hospital more.
When the ex prime minister of India underwent a very difficult cardiac by pass operation in AIIMS, New Delhi, it made such a heart warming news!
Recently Allahabad court instructed the government to make politicians and officials to send their children to government  schools to improve the pitiable conditions of these schools, I do not know it will ever work, but if it does, why not similar plans for health sector?
Some of my well meaning friends said its easy to point out already known facts, what is the remedy?
I think keeping the hospitals clean, and establishing good communication are the hall mark to make inroads in to the ailing health care system.
We need to offer human face!
(* These are Ayurvedic and Homoeopathy degrees)

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