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The young lady was brought to the small hospital in Jharkhand gasping for breath 2 hours after she had been bitten by a snake. She was quickly intubated and given the life-saving Anti-snake venom antitoxin. For the next 2 days, the junior doctor manually ventilated her round the clock as she slowly recovered. Her hand that had received the bite developed fasciitis and required a debridement. But after a week, she was ready to go home. Her bill, after heavy discounting came to Rs. 1500, mainly for the medicines that needed to be replaced. After a day, the husband brought in the money to pay the bill. Out of interest, the doctor asked him how he found the money. He said he had taken a loan from the moneylender. And the interest – Rs.10 for every Rs.100, every month. 120% annual interest. The young doctor was horrified – that was a life sentence. With the enthusiasm and altruism of youth, he offered to pay the money which could be returned to him if and when possible. But the farmer was resolute. He said it was actually a good bargain. He would never be able to repay the loan, but he would be able to work on the moneylender’s farm for the rest of his life and be sure of at least a meal a day. And when his young son was little older, he too could work and this way, his family would be secure…… For the sake of a medical bill he signed away his family into a lifetime of bonded labour.
This is a true story. It is no one-off event. It is repeated nearly every day in the villages of our country, where decades of suppression and government apathy have created a feudal system that would be unthinkable in a modern, educated society. A system that has bled the poor to feed the rich. A system that has sparked the rise of a violent movement that, according to our home minister, is the greatest threat to our national integrity. A system that is due, at least in some degree, to the corruption and avarice of those whose vocation it is to serve – our doctors.
A survey by Transparency International found that after the police, healthcare was the most corrupt service sector in
And this is no secret. Every patient who goes to a doctor goes with mixed emotions. There is always hope – that the doctor will find the cause of the problem and treat it. But there is also fear – of the possibly unnecessary investigations, procedures and medicines that the doctor will order, knowing that every stroke of his or her pen is directly translated to some personal perk or benefit. The rich have no problem with this system. As with every form of corruption, it is the poor who suffer. Official statistics indicate that about 20,000 farmers have committed suicide since 1997 with poverty being the root cause in most cases. And the World Bank has estimated that one-fourth of all patients admitted to a hospital in
Hippocrates refusing gifts of Artaxerxes the king
In today’s world, there are 2 forces that drive our doctors. The more common one is the monetary drive, where decisions of health practice are driven by the higher salary, cut or perk. The more acceptable one is the drive for excellence, be it professional or academic. But there is a third drive – that is often forgotten. In our dedication to either monetary gain or professional advancement (or both), we often subdue the drive that should be given primary importance by anyone who has sworn the Hippocratic Oath – the drive of service. But service is often pushed to the back of our mind during our medical education and practice. The number of doctors even from Christian medical colleges who serve in ‘areas of need’ are so few and far between.
When Nero was burning the Jews at stake in full view of the whole population, including the distinguished leaders of all the conquered kingdoms, when Hitler was exterminating the Jews with implicit knowledge of the Christian church and the educated population of Germany, it was the silence of those who knew better that allowed them to perpetuate these abominations against humanity. And today, many of us doctors participate in a system that is designed to make us richer and the poor, poorer. When Peter was running away from probable crucifixion in
Quo Vadis, doctor? Our country desperately needs more health professionals who will respond to the need and heed the cry of the millions of Indians who suffer under the yoke that the medical system places on them. Men and women of character, who have the courage of conviction to stand against the tide and make a difference like Dr. AK Tharien, Drs. Raj and Mabel Arole, Drs. Abhay and Rani Bang and so many others. The issues are not always so simplistic, but we need to make a start somewhere. Individual decisions need to be made until, over time, we reach the ‘tipping point’ when the flow of health care service will turn from being doctor-centric to patient-centric. It sounds impossible given the present situation, but that day will surely come. And it could start with you and me.
A young doctor stood at the bedside of a patient. This man had survived a major emergency operation in spite of a host of complications. He and his young daughter were extremely grateful to the doctor, but were pleading for a reduction in his bill. The young man took the plea to his boss, but was refused. The next day, the patient was gone, bill paid. Nine months later, the doctor saw his patient again. He had come for the birth of his daughter’s first child. The doctor was confused, remembering the beautiful young girl who had begged for a bill reduction. ‘But I thought she was unmarried,’ he said. ‘She is,’ replied the man, with a bowed head. ‘I sold her virginity to pay my bill.’
This is a true story. Quo Vadis, doctor? Quo Vadis?
 Sanjay Kumar. ‘Healthcare is among the most corrupt services in India.’ BMJ 2003; 326 : 10 doi: 10.1136/bmj.326.7379.10/c (Published 4 January 2003)