Is the doctor’s fee unusually heavy on your pocket?
For the privileged of the society, this question barely affects the peace of mind but for the poor, falling sick and not being able to afford healthcare is among their scariest nightmares. I am not talking about critical or chronic diseases like cancer, cardiovascular, and kidney diseases which cost a fortune to treat. I am speaking of easily treatable ones like viral fever, stomach flu, diarrhoea, etc.
When a person survives hand to mouth, visiting a doctor becomes a luxury. Not only because he/she must pay the consultation fee but the cost of travel, medicine, pathology test (if any), and of course loss of a day’s wage, all add up to out of pocket expense.
India is among those countries in the world that provide free or low-cost healthcare to all its citizens. Most developed countries even though have a universal healthcare system in place do not offer free healthcare service to its citizens. For example, in the US, if one does not have a medical insurance, one may end up paying up to $250 just for an x-ray. While the same in India costs just 200 rupees at a private lab and nothing at a government one. A person does not compulsorily need insurance to access healthcare without bleeding their wallets dry in India.
The problem is the population. The number of people seeking medical treatments is overwhelming. Most government hospitals in the country are not equipped to provide adequate aid to these people. With 23.6% of 1.3 billion people below the Line of Poverty just 28,000 government run primary health care centers and 35,000 government hospitals (of which only 2% are in the rural India) with 1.3 million beds is not enough.
The doctors are almost always overworked. When I recently sought getting my mother operated in a government hospital, I was simply dumbfounded how much load the doctors and the nurses at the hospital faced.
The doctor who was to operate on my mother had conducted 3 surgeries before my mother’s. One of them was of a woman with ovarian cancer that took over 3 hours. One of the doctors from the team also had to do a night shift after having worked in the OT since 10 in the morning. One nurse was assigned to take care of 40 patients in a single ward. Three women with their new born babies in their hands were being shifted to post-natal ward on a single stretcher.
The condition is bad, yes, but all these people are also doing the amazing work of providing treatments like that of cancer completely free of cost. Affordable healthcare is available in the country. It is just not enough to deal with the blatantly high number of people seeking it.
The rich can easily access both a medical insurance and health-care in private hospitals. Private hospitals do provide world class medical facilities so much so that it has started flourishing through medical tourism. But with 276 million people still below line of poverty, it is not something that the majority of India’s population can afford.
And that’s what I loved about Smile on Wheels when I first visited one. Bringing quality primary healthcare at the doorsteps of people who cannot afford to seek healthcare at private clinics or have no time to spare to go to a government one, SoW is an attempt to help people get basic medical aid which is their right – people who can’t afford or can’t easily reach primary healthcare clinics.
It was heart-warming to see people wait for the van to receive their medicines, to get their sugar level diagnosed and pregnant women get the crucial supplements they needed for ante natal care which they wouldn’t generally have cared for.
My favorite moment of all was when the doctor went to the house of a woman who couldn’t come to the van to get her medicines and sugar levels checks because she didn’t have a leg. The dedication of these doctors, nurses, pharmacists, community mobilizers, and coordinators who work on each of these vans is what is required to bring the greater change.
An incident from another assignment came to my mind as I saw the doctor dress a massive wound on a man foot – a 60 year old who got injured and lost his life in the cyclone because he could not be brought to the nearest clinic in time which was 7 kms from the village. If only, something like SoW van was available or even a basic clinic with a first aid box with some medicines, some gauze, some cotton, some betadine and some thread to stitch a wound. A life that was lost because of excessive loss of blood from a head wound could have been saved.
It all starts with basics and that is what SoW is all about. Providing paracetamol for fever; ORS for diarrhea; insulin for sugar control; iron folic acid, calcium and multivitamins for ANC and pain relief gel for joint and muscle pain. It all about creating awareness, inculcating health seeking behavior, about maintaining proper hygiene, teaching importance of breastfeeding for infants and kangaroo care technique to new mothers and more.
There is a dire need of affordable and quality primary healthcare being easily accessible to the poor of this country. Of the total GDP, a marginal 1.02% of it being spent on health care, is not enough. Even the 42 SoW vans that serve over a million people in a year, is just a drop in the ocean.
Yes, it is not much but it definitely is a lot. A step towards bringing quality healthcare within the reach of the poor is a lot. After all, an ocean is eventually made by water drops coming together.