For a country that spends less than 4% of its GDP on healthcare, even war-torn Afghanistan spends 8%, its financially-constrained healthcare system has left millions of people to fend for their own healthy survival.
‘India is everything they say it is,’ and still, ‘has nothing’. Its billion plus population may have only one medical doctor per 100,000, but there are varied prescriptions for disease prevention and control to choose from. From folk, spiritual, herbal or ritual approaches to ayurveda, yoga, siddha, homeopathy and naturopathy techniques, there is one for every pocket and faith. How people get treated is as much a reflection of their social and economic status as their unstinted faith in the chosen system of health care. Why people are drawn to such alternatives is the leading question Aarthi Prasad, whose maternal grandfather was an Ayurvedic doctor and secretary to the Chopra Committee set up shortly after Independence in 1946-48 to chart the way forward for Indian healthcare, seeks to explore the many faces of medicine in her journey across modern India.
For a country that spends less than 4% of its GDP on healthcare, even war-torn Afghanistan spends 8%, its financially-constrained healthcare system has left millions of people to fend for their own healthy survival. It is quite simply economic folly for a country to sacrifice its people, and leave them vulnerable to exploitation by quacks and fake doctors who dispense medicines, antibiotics and steroids in a grossly unregulated health sector. Reports of people dying at the hands of such untrained practitioners with dubious qualifications are a common occurrence. On the other extreme, there are social entrepreneurs who have seized the situation to create modules of effective healthcare delivery for the poor that the state and many overseas governments have begun to emulate. That there exists a range of possibilities amidst the healthcare gloom, other than just increasing the number of trained medical doctors, is the central message emanating from In the Bonesetter’s Waiting Room.
In eight well-written chapters, Prasad takes the reader through the maze of health care challenges that are being confronted on a daily basis by a range of health innovators. From a traditional healer who knows the medicinal value of every plant he finds to a group of women who are working together to address mental illness in country’s mega-slum, and from an asthma healer who prescribes swallowing a live fish to a group of doctors who are taking community health system to tribal living in remote jungle, the author treks the length and breadth of the country to provide a unique perspective on health and survival in one of the most fascinating country in the world. The author, however, concludes that capturing the breadth and diversity of the practice of medicine in India is immense in its scope, as the provision of generating such knowledge dates back to several millennia in the country.
But can such good Samaritan efforts be enough to transform the inadequately resourced and underfunded state health sector? Nagging as the question may be, the answer lies in the realization that ‘people have to be the actors and advocates in order to make a difference’. Each of the health innovators featured in the book are optimistic about connecting with right people to influence government resources in the right direction. Though adoption of learning from non-state actors’ initiatives is often frustratingly slow, the trickle-down effect is being observed in few isolated cases. Drs Abhay and Rani Bang’s community-care initiative, called SEARCH, in the jungle of naxalite-infested Gadchiroli in Maharashtra caught the attention of the Indian government only after it was taken up in Nepal, Bangladesh, Malawi, Zambia and Ethiopia.
The message that comes across from the initiative is loud and clear: reduce unnecessary pressure on the beleaguered health infrastructure albeit government hospitals and take health-care instead to the people by targeting areas that have least of such facilities. Else, reaching out to nearly 800 million people with poor access to healthcare, given that India’s doctor-patient ration is 1:2000, will remain a distant dream. Nothing could be more evident than the plight of 700,000 people confined within 535 acres in world’s second largest slum Dharavi in Mumbai, which is home to a random assortment of skin, mental and venereal diseases.
What’s more, learnt Prasad, while sick men are taken to a hospital, woman in the same situation is just given a dose of simple painkillers and allowed to suffer in the most inhospitable slum dwelling. Gender discrimination is shocking feature of life in slums, wife-beating, abandonment and divorce are common. Were it not for the timely counseling by the dedicated team of SNEHA, an initiative set-up by social psychology Nayreen Daruwala, women would have been bereft of much needed psychological therapy which is often reserved for upward mobile urban population.
With a PhD in molecular genetics and an interdisciplinary research engagement at London’s University College, Prasad delves into the technological divide afflicting country’s health sector to reveal how a strategic merging the traditional with the modern system of medicine can help credible healthcare reach out to the culturally and economically diverse population of the country. The pluralist culture of medicine is both a bane and boon, she argues. It is, however, another matter that it has taken decades for the government to harness synergy between different systems of medicine. The Chopra Committee had long recommended ‘synthesis of Indian and western medicines is not only possible but practicable’, but at that time modern medicine was considered the basis for development in the new India.
It took nearly six decades before the government could create the Ministry of AYUSH, which covers the practice of Ayurveda, Yoga, Siddha, Unani, Homeopathy and Naturopathy, to bring these practices in the mainstream of health care in the country that has long practiced all these form in one way or the other. Need it be said in a country where, according to the World Health Organization, seventy per cent of the population still accesses traditional treatments. And, it is no less revealing that AYUSH hospitals now offer 62,000 beds backed an army of 785,000 health workers. Without doubt, traditional medicine could be most desirable add-on to modern medicine in reaching out to teeming millions with affordable health care.
Full of interesting revelations and intriguing insights, In the Bonesetter’s Waiting Room captures the sound bites from the by-lanes of healthcare have-nots. It is country where unflinching faith in magic and medicine flows in an unholy alliance, leading to unsubstantiated assertions like: ‘I prayed to goddess and my wife was cured of TB’. While the cause-effect relationship of such claim may concern a doctor, it matters least to the person whose wife eventually got cured. Such cultural diversity beseeches a system of medicine that is as close to the skin as it is to the soul of its people.
Aarthi Prasad deserves credit for bringing selected stories from the country’s vast healthcare landscape to life. The writing is superb; the non-fiction story telling format doesn’t miss out on the minutest of details. A reader can’t escape the disgusting stench as the author wades through the filthy water in slums of Dharavi and nor can one miss the exquisite ambiance of the up-market cosmetic surgery clinic as the author engages in discussion on the emerging market of plastic surgery in the country. The author rightly concludes that the challenges and solutions to the health of this great nation are not as diaphanous as it may seem. It calls for a pluralistic understanding of the society and its people.
(Dr. Sudhirendar Sharma is Director, Ecological Foundation, New Delhi, India.)
In The Bonesetters’s Waiting Room
by Aarthi Prasad
Hachette. New Delhi, 2016
Extent 214 pp, Price: Rs 499
(First published in Biblio: A Review of Books, Sept-Nov 2016)