Politics of Medical Service

Serve the People
Debasish Paul

[Dr Binayak Sen,  who has rendered selflessly and promoted medical service among tribals of Chhattishgarh and is internationally acclaimed, is given life imprisonment for regicide. But why?]

Medical science is one of the most ancient discourses of human quest of knowledge since life and death of animal are the two most important aspects of start to end of life cycle of living Beings, hence medical service is an universal need required since mankind appeared on the earth. In course of social evolution from Primitive Communism to Feudalism and onward into Capitalism/Socialism Medical profession has undergone attributive changes. Hippocratic Oath is chanted all over the earth by Medically qualified Professionals while taking practicing license from Medical Council of the concerned state, to treat everyone falling ill and the doctor is called in, immediately and unconditionally. But in practice physicians have become virtual front end Sales persons/commission agents of business of medicine as a commodity churned out by producers of drugs and medicines and profit sharing of revenue of services of traditional Bio-Chemical diagnostic testing centres whose monthly turnovers often reach astronomical figures from initial days thousands to beyond cumulative lacs. Physicians barring a few, are also opportunist vicious sales promoters of Bio-Electronic / Nuclear machine based hi-tech diagnostic centres who make big bucks of sales revenue shared on commissions basis with the referring Physicians. Suffice it to say that Capitalism converts all goods and services into commodities. Pharmaceuticals, diago-nistic laboratories and physicians are role players. In exploitation of ill suffering patients who respect Doctors as Gods and try their best to obey the prescriptions religiously even sometimes beyond their means. On the contrary, even in non-socialist Welfare Economies and obviously Socialist countries the governments directly offer free or subsidized public health services and also actively control medical business of private enterprises in research and produce of medicine, diagnostics and Doctors' healing services.

Indian medical science is acknowledged as one of very ancient origin whether it is Medicine or Surgery. The available books of Indian medical science is called 'Ayurveda'—Science of longevities which was innovated in the holy ashramas where God inspired sages dedicated to human welfare invented and authored the books on medicines and techniques of surgery. The sage physicians considered healing the patients as religious acts and not commercial services.

Since 'Ayurveda' means life science,-of the four volumes of 'Ayurveda', the first three are repositories of experimental truths focused on the mode of ideal lifestyle along the advancing age of a person moving from being a new baby and the mother to young to senior citizen ending in old age and demise ,it was a kind of Ancient Preventive Medicine suggesting elaborative how health as wealth is to be preserved by the preventive perfection of lifestyle from birth to death, including discipline of food habit supported by Yogic exercises. Thus Indian approach centered on Preventive Medicine.

Pranayam is the core of Yogic discipline of Indian medical science of preventive and curative approaches—two in one so that a man would not fall ill but would have a long life with good health. In Mixed economy of India private business and industry of recuperation are allowed side by side with government initiatives as enshrined in constitution. It has its worst fallouts in health sector becoming a vicious circle of exploitation of human being in distress.

Clinical medicine is in the fifth volume of Ayurveda which suggested different organic sources of medicinal plants which can be cultivated as accessible source of medicine for preventive and curative process. Ancient Indian science of medicine was focused on welfare and not cashing in on illness of human being.

In Indian civilization medical service was not by any means a commercial profession allured to get rich quick kind of western capitalist enterprise of money making exploiting on human misery. In the period when the British colonized India, Capitalism had its steady evolution. So western medical service of Doctors turned it into an elite profession of huge money making as well the diagnostic enterprise and production and sale of medicine had become lucrative pure trade and commerce.

One gets in Rabindric literature in form of dance drama that a young sage (Sanyasi) Upagupta completely treated an erotically most popular and favourite public woman thrown out of city walls once she caught Pox. Upagupta did not care whether the lady was a courtesan by profession who entertained the sex hungry rich. She was quite famous in her profession for enormous beauty and skills of entertainment but once fallen ill in an infectious disease like Pox, was brutally thrown away. But above all, her treatment without profit was a noble example of humanity of oriental treatment of the ill. At an earlier date, the young healer was Adonis, so the courtesan proposed her love and sexual company but the young sage cum physician politely refused the offer while promising to come at the time most appropriate to accompany her.

In a famous Academy Awarded novel of litterateur Tarashankar Bandopadhyay, later also made a film of the same name 'Arogya Niketan', the Ayurvedic doctor even amidst chill penury told that cure of the ill was his religion and not a commercial service rendered. He charged no fees but in respect the patient villagers escorts brought agricultural crops and vegetables for livelihood of the physician(called Kabiraj or Vaidya).

In post-independence India, the Public Health system in metros, towns, moffussil and rural areas and medical colleges attached hospitals has suffered a steep decline in service rendered, partly by design, partly by default. It created an explosion of patients when with burst in population growth in eastern India particularly in West Bengal for mass scale immigration on and from 15th August 1947 and in Bangladesh War 1971. Mofussil areas around Kolkata and areas nearby Bangladesh frontier, uprooted people, in particular the poor people have suffered their way to untreated death in absence of adequate public health service. In order to add insult to injury, quack doctors filled up the gap of qualified doctors and made a hay when the sun shines.

In subsequent years, proliferation of nursing homes opened up by the opportunity created for greedy businessmen in collusion quite often with physicians posted in adjacent Public Health Service Centres playing truant from duty even in duty hours not attending ill and vulnerable causing steep deterioration in whatever primary care and cure was possible in government Primary Health Centres. It killed two birds in one stone by deteriorating PHC service and flourishing private practice in makeshift clinics euphemistically called Nursing Homes. Money is sweeter than honey. People practicing medicine are rudely unscrupulous in private practice in nursing homes which often lacked basic infrastructure essential for basic medical treatment.

Private hospitals in big cities have country cousins maintaining symbiotic relationship since birds of a feather flock together. Exploit every patient on the basic principle of the practice of vampire. Poor patients are sucked upto their last paisa in local private health clinics while richer patients are referred to private nursing homes in nearby metro cities.

The self proclaimed Left Front government ruling at a stretch for thirty four years indulged in erosion of Public Health Centres. All Pubic Health Centres suffered erosion of public health amenities while some left front politically favoured suppliers of medicines and other medical consumables store materials, at the same time supplied substandard goods with inflated supply invoices in a full circle of rackets including MP, MLA like public representatives, PHC and hospital officials and all cadres of public servants associated in these health terminals. So cure centres became procure centres of unscrupulous transactions making big bucks of large scale plunders at the blessings of District Medical Officers. Everyone enjoyed their pound of flesh sharing their fortune with the Left (all consciences left behind) administrators of public health and politicians of the region. Shame is the name of the game.

Public health compounds everywhere degenerated to towering inferno. Medical insurance companies were victims of the malady unconsciously at the corporate level while some insiders of health insurance companies in different cadres were hand in glove with private medical establishments to fleece their own concerns. The unionized employees are shock protected against all sins whose yields are shared in right proportions in a chain with all unscrupulous elements of health insuring companies. In precise all gained inside and outside the medical centres save and except the poor ill patients for whom medical centres were dedicated.In Bengali language it reminds the proverb 'Ulta bujhli Ram' that means it is the reverse that happened just opposite of the mission.

What is the principal contradiction of the jaundiced service of public health? Why life and death of man has gone to the mercy of service establishments, while medicines imbibe the character of commodity fetishism.

One has to identify the endogenous and exogenous factors affecting the malady. It is the external primary factor that is what is the nature of state. In an individualistic or Mixed Economy state poor patients are denied healing service as opposed to socialist state where treatment is full and freely provided by state to the people not considering economic status of the ill.

It is amazing to observe that while the citadel of Capitalism and Imperialism that is in Great Britain, the state provides full support to all kinds of citizens treatment, in a declared socialistic pattern of state like India, poor citizens, from urban to village areas in need of cure, are not at all adequately served by state medical services, despite the government spending billions on medicine, doctors, para-medical staffs, menials, infrastructure and administration on clinical public health.

Doctors who are educated in government medical colleges get subsidized training to the extent of ten times what they pay as tuition fees, are under no commitment to serve the people. Doctors grown up in private medical colleges under capitation fees of astronomical figures consider their expenses as this is the best track of gold rush, once they grab the degree.

So western medicine introduced by British colonialist has successfully redefined the Indian approach to medical service from religion to a profession of unbridled expressway of wealth accumulation. It is no surprise because British are well known as nation of shopkeepers but in independent India right to life being fundamental one, the state is committed to ensure good life of the people. Hence Dr Binayak Sen, a human rights activist, has rightly said that medical service is ultimately a political issue.

Anybody or organisation who would try to reverse the medical profession back to serve the people instead of exploiting the misery of ailing common man commercially, would disturb the vicious circle from end to end and would be target in hit list like Dr B Sen, physician and also a human rights activist.

Vol. 45, No. 5, Aug 12-18, 2012