Machinations of medicine

Governments come out with health schemes for the welfare of people. Of late, the new CM of Andhra Pradesh (AP) has also promised to introduce the modified Arogyasri scheme; Rajasthan government is even getting ready to enact the 'Right to health' law. But the moot question is whether the medical systems in place to provide these facilities are in order since the present-day vulture-culture has invaded the medical field as well. The adage, Vaidyo Narayana Hari, is now a thing of the past.

Applicable to all those whose income is less than Rs 5 lakh per year, Arogyasri scheme of AP would meet all the medical expenditure beyond Rs 1000, and special pension to patients of Kidney, Thalsamia, etc. Sounds good. In Rajasthan, however, while preparing to enact the 'Right to Health' law, the CM has called upon private players to serve society instead of making healthcare a business. It is true that in the absence of effective monitoring systems, the efficacy of such schemes has left abundant scope for their misuse.

There were times, perhaps till a couple of decades ago, when respectability, social status and great professional satisfaction in bringing relief to patients, symbolised a man of medicine. Such was the competition among aspirants that only the brightest students could become doctors. Reservations have compromised on the quality to some extent. However, with the proliferation of private medical colleges and the active connivance of the notoriously corrupt Medical Council of India on one hand, and corporate hospitals working for profiteering on the other, medical profession has simply become a mere business. Like in politics, those who buy the donation-seats also treat it as an investment and work for recouping it as quickly as they can. Now, fallen from the grace of Vaidyo Narayana Hari, a doctor is just another indispensable businessman. With their focus always on expensive medical tests, surgeries, etc., a corporate hospital is a dreaded but unavoidable place.

As a result, doctors with conscience and ethical values have become a rare breed. Although it is very essential to allow the natural biological processes of the body to fight diseases on their own, they are being deliberately ignored. In this context, one is reminded of the schooldays story of the life-cycle of a butterfly. A restless student makes an incision on the pupa to help the butterfly to come out. But it dies. The teacher explains, 'We should know that each stage has a purpose. The butterfly lays its eggs on a selected leaf so that the caterpillar would be able to feed itself. The caterpillar sheds its skin several times as it grows since its skin cannot expand. The stage of pupa is for the metamorphosis of its tissues, limbs, and organs into a butterfly. When it comes out, it rests for a while before blood is pumped into its wings to enable it to fly. And then it starts hunting for a mate in order to reproduce.' The lesson is that natural processes cannot be ignored.

While we are helpless when it comes to pollution of water, air, food and epidemics, and some major problems like cancer, etc., we are certainly blessed by nature with robust biological mechanisms to take care of most of the external aggressions of bacteria, virus, etc., by generating the required immunity through WBCs and anti-bodies. Yet, unaware of it, or being impatient, most of us rush to a doctor, although medication only deprives the body of developing the anti-bodies and makes it vulnerable to future attacks. Most of us are also not aware of how Nature has provided us with several varieties of food that give us strength and immunity. There is a change in our culture too; we scoff at a doctor who sincerely desists from prescribing unwanted medicines.

For example, a good doctor clinically finds that the reason for the headache of a rickshaw puller is the heat of summer and advises him rest and liberal glasses of buttermilk. Not satisfied, the man goes to a neuro-surgeon. After an expensive MRI and other tests, the specialist also finds nothing but prescribes some medicines to satisfy the man and the hospital. In another example, a house-maid slips down while working in a house and is unable to walk. Clinical examination by the humble doctor reveals no fracture, and he prescribes a balm for the sprain. However, cautioned by her neighbour, she goes to the orthopaedic surgeon, who too comes to the same conclusion after X-ray tests, and puts a bandage. Only that she shells out a good amount for this show. Hospitals and doctors wait for such opportunities. They would love to be partners in government schemes for obvious reasons. They feel blessed if they can entrap patients with tonsillitis, uterus problems, and of course, anything heart-related, etc., since tonsillectomy, hysterectomy, by-pass surgeries, etc., would fetch them substantial amounts.

Surgical removal of tonsils, which are the first line of defence against bacteria and virus that enter through the mouth, especially for children in whom anti-bodies are not yet adequately developed, is in principle resorted to only when the inflammation occurs too frequently, or when there are other diseases affecting them. A study in the UK revealed that only 13.6 per cent of such patients underwent a tonsillectomy, and that one is not sure of benefits they got for this, proving that it is not really essential. It is also found that in general, surgeons, who are paid fee-for-service, perform unnecessary surgeries than those who are paid a fixed salary. In India too, government hospitals desist from conducting them while it is liberally done in private hospitals.

Same is the case with hysterectomy, which is surgical removal of the uterus, or the womb as it is called. For a woman, uterus represents femininity, since it plays a crucial role in fertility and childbearing, and also in sexual response by directing blood flow to the concerned parts, including the genitals. Normally, a woman requires this surgery when there is untreatable excessive bleeding or diseases like cancer affecting her uterus. While bringing relief to patients, this surgery also has the potential of affecting them psychologically; it can also cause pelvic prolapse, in which the neighbouring organs may collapse into the vacant space created; and with estrogen levels changed, it may also affect sex. In about 12 per cent cases of hysterectomy, patients suffer from pelvic prolapse and urinary problems and require corrective surgery. Hormone therapy is needed to enhance estrogen levels needed for intercourse. Thus, this major surgery should be conducted only when it is very essential. But, those in the vulture-culture do not think so. Conscientious doctors lament that almost every woman above the age of 22 in Khammam district of AP is left with no uterus, portraying low ethical values.

The prime slot in private hospitals is occupied by expensive by-pass surgeries. It is intimidating for the patient to go; they also feel scary not to go. Here is where government schemes come to their rescue. Then, we also have rackets of kidney transplantation. The cases against the corporate hospitals of Vizag – Seven Hills in 2014 and now Shraddha – speak about the nadir of ethics in the medical profession. Although the sale of kidneys is prohibited by law, poor people are lured with big money to become donors. But, giving them only a pittance, doctors, hospitals and the middlemen pocket the rest of about Rs 30 lakh collected for the surgery by fudging Adhaar cards, etc.

Though the government medicare is essential, one thing is sure; for every problem, one does not need medication or surgery. Moreover, the preventive aspect is vital for good health. With the advent of social media tools, there is increasing awareness among the educated class about naturopathy, home remedies and natural foods. There is an increasing demand for millets for their nutritional value. Similarly, more people are becoming wary of several leafy vegetables – drum-stick leaves, curry leaves, mint, gudari sag, etc., which have both medicinal and nutritional value. They are gaining knowledge that ginger, garlic, cloves, coriander, fennels, methi, etc., can prevent and treat several diseases – of eye, diabetes, BP, etc. For example, it is known to some that a simple home-remedy of intake of coriander power works wonders for excessive bleeding in the uterus; expensive hysterectomy with the attendant side-effects is not needed. Then, Sujoku, acupressure, etc., are also being successfully tried for many ailments. Yoga, mudras, etc., also have immense preventive and curative values.

Yet, the common man has no access to such information. Further, at times, information available on social media is not reliable. What is needed is an organised form of communication of authentic information and proper guidance. For this, the Chinese experience of barefoot doctors could become relevant in our large country.

Selected people could be trained and imparted knowledge about home remedies and foods, first aid, alternative medicine, need and time for visiting doctors, etc. Such health workers, located in villages and mohallas of towns and cities can not only educate people on nutrition and diseases, and help them with immediate remedies, but can also provide the right guidance and reference to appropriate doctors when needed. Since they work in the same society they live in, they would generate confidence among people.

There would thus be an inhibition to take unnecessary medication, like the much-advertised antacids, etc., available across the counter. There would be no unnecessary visits to doctors. It will also help in countering the unethical practices by medical practitioners and hospitals and proper utilisation of funds earmarked under the health schemes.

(Dr. N Dilip Kumar, IPS (retd) is a former Member of Public Grievances Commission, Delhi. The views expressed are strictly personal)