It has been announced by our Medical Education Minister that the government is considering the launching of a scheme that would take medical care to the doorsteps of all citizens. This announcement is the heralding of a hitherto unattempted and untried way of dispensing medicine to those who are unwilling or otherwise unable to go over to our government hospitals for various reasons.

The intentions of the government in doing this may be very good as this aims at putting the health of citizens on a high priority. But what has to be understood here is that in the attempt to take medical care to those who may need it most, government doctors and their auxiliary staff will have to waste much time and effort in knocking at the doors of even those who may not be in need of their help. Many people will certainly resent being disturbed by a government medical team knocking at their doors from time to time, trying to pry into their personal lives and peddling medical care which they do not need. I, for certain, would not like it one bit.

Many people even consider frequent house calls from census and electoral roll enumerators a nuisance although it is a very necessary activity in any democratic country. This new health care endeavour will place a huge logistic burden on the medical teams and the administrative machinery that will have to govern and monitor their work. Since the already overworked existing staff of our government hospitals certainly cannot be expected to take up this mammoth additional job, a new cadre of workers will naturally have to be inducted for it.

From where will the government recruit additional staff and pay their salaries that will almost double the burden to the State exchequer? Our government hospitals at present often attract more criticism than patients because they are not of much use to people. Citizens, even those who can ill - afford the high cost of privatized health care, frequently turn to private doctors and hospitals only because the government agencies do not meet their expectations.

I would like to give you just one example of the many handicaps that doctors at government hospitals have to face. I was recently passing through a very small town where a friend of mine happened to be the government medical officer. Thinking that it would be a good thing to say hello to him, I called on him at the government primary health centre which was his place of work. He was very surprised and pleased to see me and asked me to be seated while he disposed off the last few of his patients for the day. I sat across his table and watched him at work. An elderly patient accompanied by his son came and sat on the examining table. My friend proceeded to take a history of his symptoms which to me seemed very clearly related to hyperacidity.

After examining him he was writing the prescription when the patient’s son asked what the problem was with his father. Much to my surprise and shock, since I had listened to the symptoms described by the patient, my friend said that his father was suffering from Anaemia, a lack of blood for which he would prescribe some vitamins and iron tablets. I knew that he was not so dumb a clinician to be making a wrong diagnosis in this simple and straightforward case. But I thought it wise to keep quiet till the father and son duo left and then asked my friend why he told them such a blatant lie about the real diagnosis which was not at all a grave one that could frighten them.

He looked at me with a rather sad expression and said "You have never been in government service and so you will never understand the peculiar circumstances under which we government doctors have to work. Right now our dispensary does not have any stock of medicines to treat hyperacidity. I have been trying to get our stocks replenished for the last one month without any success. The department sends us huge stocks of medicines which are almost of no use to us as ailments that can be treated with them are very rare here. But it fails to give us adequate supplies of some of the medicines that we need most to treat the most common diseases.

"When I complain, people above me tell me that medicines are purchased by the government under various pressures and compulsions from powerful politicians which results in the stockpiling of useless drugs which have to be liquidated before their expiry dates even though the diseases that can be treated with them do not exist in a particular area. Although we have almost no cases of malaria, we get huge stocks of anti - malarial drugs and likewise is the case of drugs to treat filariasis which is found only in the coastal belt that lies hundreds of miles from here.

"Now if I prescribe the correct medicines to treat this man's hyperacidity and ask him to buy it from outside his people will complain to the MLA that the government hospital doctors are in collusion with the local chemists and therefore issue only prescriptions instead of drugs. They will even blame me of selling government supply drugs on the sly which most people will also believe quite readily since I have the dubious distinction of being a government servant. This lands me in trouble which I naturally try to avoid by making a diagnosis appropriate to the stocks of medicines that we have rather than to the ailment which the patient has! This is a common practice and all my colleagues do it too.

"The best part of this sad situation is that when the medicine I have issued from here today has no effect on the patient’s symptoms in a couple of days he will soon return with a request for better and costlier drugs from outside which I will then prescribe without any risk to my job or reputation!"

I was benumbed by this revelation which showed me where our government health care stood. Instead of embarking on this new “mission impossible” it would be better if the government concentrates its efforts on better equipping the existing government hospitals and providing adequate stocks of the medicines most required to make them more useful to the common man. Further, if it can improve the living conditions for government doctors and their families in the rural areas it can make them more committed to stay and work there instead of being in a perpetual struggle to get transferred to urban areas. Trying to take handicapped health care to people’s doorsteps will only be like taking a reluctant and even lame horse to the water it does not wish to drink.

Dr. K. Javeed Nayeem, MD
e-mail: kjnmysore@gmail.com
Courtesy: Star Of Mysore