Commentary 24/08/22 India: An ailing nation, a sick society

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India: An ailing nation, a sick society

Very little can divert attention from the crisis it faces in bringing nutrition and healthcare to its 1.4 billion people

Medical professionals and activists hold stethoscopes and wave the Indian flag as they take part in a midnight protest to condemn the rape and murder of a young medic, in Kolkata, on Aug. 14, the eve of India’s 78th Independence Day celebrations. (Photo: AFP)

By John Dayal

Published: August 22, 2024 05:14 AM GMT

Updated: August 22, 2024 06:02 AM GMT

Sometime later this year, if all goes well in India and the United States, India will send its second citizen into space. The first one, fighter pilot Rakesh Sharma, was on board a Soviet spacecraft in 1984. The next, also an air force pilot, will be on board a NASA rocket heading to the International Space Station.

India will launch its own manned space flight later this decade, the crowning achievement for Prime Minister Narendra Modi’s three-term regime. He has milked the space progress well.

India recently landed a spacecraft on the “dark” side of the moon, the first nation to do so.

It does not matter that American Neil Armstrong stepped on the moon in July 1969, and since then Russia and China, among others, have sent objects up high, and some have brought back lunar rocks.

Modi has made his own personal “space race” the highlight of his national addresses, which he makes in his high warrior turban, saying he has made India a Vishwa Guru, a teacher to the universe. He will achieve what could not be achieved by Jawaharlal Nehru and Indira Gandhi, the long-dead Congress leaders he sees as his main competitors for historical glory.

He needs it to keep the spotlight firmly away from the crisis India faces in bringing nutrition and healthcare to its 1.4 billion citizens, with perhaps two-thirds of them in villages and forest homes far from the nearest administrative office with its Primary Health Centers — the state-owned rural and urban healthcare facilities in India.

Very little can divert attention from the severity of the violence. The outrage over the recent rape and murder of a young doctor in Kolkata, West Bengal, is seemingly the main topic covered by national television. It will, however, quietly cease when the regime finds it politically no longer useful.

"India, including its criminal justice system right up to the highest courts, is seemingly inured to the incidence of rape"

The media has not covered a similar rape and murder of another medical professional, a Muslim nurse, in Nainital, Uttarakhand. While Bengal is ruled by the Trinamool Congress, Uttarakhand has a government under the Bhartiya Janata Party (BJP).  Perhaps the reason is not political; just religious, as happens often in highly polarised India.

Rapes in general, or attacks on medical personnel by angry or frustrated, or just rapacious people are not uncommon. Every hospital has a board saying it is a federal crime to attack a doctor or nurse. It is also a federal crime to attack anyone — doctor, engineer, or road laborer.

India does not have laws covering malpractice by doctors and nurses.

India, including its criminal justice system right up to the highest courts, is seemingly inured to the incidence of rape. In 2020, the apex court confirmed the death sentence on four young men who gang-raped a student physiotherapist and then killed her in 2012. The four were hanged in a Delhi jail.

The Supreme Court recently set up a committee to see what systems can be set in place to prevent the sort of heinous attack that took place against the young doctor in Kolkata.

It has taken no notice of public protests that two godmen who are in jail for multiple rapes and murders are let off on parole several times a year for the flimsiest of reasons. Asaram Bapu from western Gujarat state was very close to Modi, till he was convicted of raping his devotees and associates.

Ram Rahim of Haryana has rape, and the castration of his devotees, on his crime chart. He too roams the land free every time there is an election in the state or the nation. He has political clout in the northern Haryana-Punjab region.

Like the courts, parliament too takes rape in its stride.  The Association for Democratic Reforms (ADR), which monitors parliamentary processes, in its recent report said 151 members of parliament and state legislators have declared “cases related to crimes against women” in their election affidavits.

It examined 4,693 out of 4,809 affidavits of MPs and state legislative assembly members (MLAs) submitted to the Election Commission of India during elections between 2019 and 2024.

"There has been suspicion voiced in the media that organs may be forcibly harvested from young people"

The ADR said 16 members declared cases related to rape, which carries a minimum sentence of 10 years and can be extended to life imprisonment. Of these, two are in parliament and 14 in state assemblies. Most, but not all, are members of the BJP, followed by the Congress.

Rape is the fourth most common crime. A 2022 report from the National Crime Research Bureau said there were 31,677 rape cases — or 80 a day — the previous year. Most women knew their rapist. The northern states of Rajasthan, Madhya Pradesh, and Uttar Pradesh topped the list, as did the national capital Delhi which still documents three or four rapes a day, the highest for any metropolis.

The national capital would, however, like to project its ranking as the top city for “medical tourism.” Delhi, with Bangalore, Chennai, and Hyderabad close behind, attract patients from Central Asia, Africa, and occasionally from Latin America who need open heart surgery, kidney and liver transplants, and other joint replacements that are not available in their countries, and too expensive in Europe or the United States.

Data assayed from major hospitals that have exclusive staff, including interpreters for “foreign guests,” say packages begin at about Rs. 500,000 (US$5,956) for knee joint replacements and open-heart multiple bypass surgeries and can go up to Rs. 2 million for liver or kidney transplants. A kidney transplant in the US can cost up to $400,000. The success rate of kidney transplants in India is said to be 98.7 percent.

It is not listed on the board, but middlemen arrange for donors when needed, bypassing strict national laws that insist kidney and liver transplants cannot be done other than from close relatives. Not long ago, a well-known hospital chain’s doctors were arrested together with middlemen who were buying organs. There has been suspicion voiced in the media that organs may be forcibly harvested from young people abducted by human trafficking gangs.

These senior surgeons are at the top of their profession — with additional degrees from well-known institutions in the US and the UK. They work in state-of-the-art surgeries, with robotic instruments for minimally invasive operations.

But most doctors, and their nursing assistants, work in government hospitals with bare necessities and equipment that is behind by up to 20 years.

As of June 2022, there were 1,308,009 doctors registered with the National Medical Commission (NMC) and the state medical councils in India, with a doctor-population ratio of 1:834. About a third of them are women.

"The food is strange, the language must be learned, and the cold is freezing"

The government projects 1,733,873 doctors registered by 2030, with more medical colleges at the planning stage. Some 750,000 students are in medical school at any given time.

There is also an equally strong corps studying Indian systems of medicine, as they are called. They share the basic curricula but cannot perform surgeries at present. Many hospitals, especially those run by the government, have doctors from the Western and Indian systems of medicine practicing in the same building.

However, medical education remains expensive, and admission tests are tough. Government colleges, some very good, remain the most economical option. Private colleges can cost from Rs.300,000 to 2.5 million a year. Arguably, the most expensive will be a four-year MBBS degree at a private university in Pune, which can cost around Rs. 20 million.

Many students who do not want to compete in the admission tests and cannot afford exorbitant fees fly off to China, Central Asia countries, the Philippines, and East Europe. The food is strange, the language must be learned, and the cold is freezing, but the degree is valid. A local test, and they can practice anywhere in India. Each year, roughly 20,000 to 25,000 Indian students study medicine abroad. 

The hospital situation remains grim. As of 2021, with 825,235 hospital beds, only one in 2,000 people could get a bed when needed. This is one reason an uncounted number of people died at the peak of the Covid crisis. Of the 713,986 beds, only 25,778 were in public hospitals, and the rest in 43,486 private hospitals. The country needs an additional 2.4 million beds.

Almost 122 Indians per 100,000 die due to poor quality of care each year, studies say, worse than Brazil, China, and South Africa.

Is providing care without ensuring the quality of health services effective? Some 2.4 million Indians die of treatable conditions every year, the worst situation among 136 nations studied for a report published in The Lancet.

The hospital crisis is overwhelmingly seen in the context of the disease load in the vast country.

A report earlier this year by Indian multinational healthcare group Apollo Hospitals dubbed India the cancer capital of the world, projecting that it could record roughly 1.6 million new cancer cases by next year. This is a 13 percent increase within five years, said the report.

India has one of the highest burdens of cardiovascular disease (CVD) worldwide. The annual number of deaths from CVD in India is projected to rise to 4.77 million. Coronary heart disease preval‎ence rates have ranged from 1.6 percent to 7.4 percent in rural populations and from 1 percent to 13.2 percent in cities and towns.

Diabetes remains the most preval‎ent ailment at 9.3 percent of the population in 2018-2024. Experts say diabetes preval‎ence will increase to 10.4 percent by 2030-2034.  A consequence is on the kidney. The Kidney Disease Data Centre Study has reported a preval‎ence of 17 percent or 150-200 per million population.

That’s the Indian conundrum — medical tourism for Central Asians, hospital crisis for the citizens.

*The views expressed in this article are those of the author and do not necessarily reflect the official editorial position of UCA News.