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Towards more robust healthcare

The public healthcare system in India is one of those topics on which most people have an opinion. It is often expressed with much energy and claimed insight. There are some favourite viewpoints. Almost all of them talk of primary, secondary and tertiary healthcare. Usually, a discourse on these aspects is accompanied by half a tear on the state of affairs in the country. The truth is that notwithstanding the enthusiasm for allopathic healthcare, this country’s primary healthcare system is nourished and sustained by Indian systems of medicine. They are easily available, the diagnosis is simple and in a large number of cases, the results are satisfactory. Traditional medicine systems do not burden the common man with endless medical tests like allopathy does, which in turn are often accompanied by protestations about the possible unreliability of the results. This is not only because of the nature of the tests but also due to the flaws in the process of testing. Often, the search for reliability means repeat tests. Interestingly, the pathology labs, as a source of livelihood, have very rarely been subjected to an analysis which tries to understand their exponential growth. Cartels are reported to be rampant in B and C-class cities, not to overlook the groupings in the smaller geographical units of megacities. It is one of those strange situations when a lot of people know what’s going on and yet nobody wants to talk about it. When talking itself is taboo, one can well imagine the plight of a possible investigation of a serious order.

Strangely enough, an engineer in the process of becoming one has to undergo certain orientations in social sciences or cognate areas. By and large, the curriculum of medical education seems to have its focus essentially on the institution of hospitals. The results are there for all to see.

The Covid era has lent these traits a grotesque veneer. By and large these days, hospitals tend to avoid giving a discharge certificate which would say whether the patient has been cured (or not) of Covid. Senior doctors take shelter behind the Indian Council of Medical Research’s guidelines. Perhaps some of this is unavoidable, yet there are cognate issues which await clarity. National protocols need to prevail but when will there be greater specificity?

The merits of this can be debated. Some will claim that it is inherent in a situation like the ongoing pandemic, where so little is known about the virus. One of the media write-ups talked of seven types of mild-Covid. Notwithstanding this categorisation, apparently, there is very little to distinguish the treatment of one Coronavirus from the other. Paracetamol et al is administered in each case and here enters the fanciful word-of-the-year: “Immunity.” The last 11 months have seen this word riding the crest as never before in human history. The Indian healthcare systems, which subscribe to “the-way-of-life being the route to health and happiness” doctrine, seem to be having the last laugh.

Right from amla to apricot, everything has become a panacea and the source of immunity and health that people swear by. It doesn’t seem to bother many that apricot itself is a seasonal fruit and cannot be the route to universal and sound health.

The second and third waves of Covid have become a widespread topic of discussion in most drawing rooms across the country. As winter approaches and cases spike, much of Europe is undergoing or threatening to undergo another spell of lockdown. Interestingly enough, few authentic figures are available of what percentage of the spike is a result of relapsed cases in patients, who were discharged from the hospital even though they had met the existing protocol of release. The ambiguity of the situation may be partly inherent but it still does not explain why the issues of treatment of different categories of Covid patients are not being pushed to their logical conclusion.

Is it not prudent to keep the patient under the care of the same set-up for a longer period of time before s/he is allowed to travel and there is a reasonable guarantee that the person will not be a candidate for a repeat infection? It is obvious that it is difficult to give firm answers to these tricky questions. However, it is pathetic that the broad contours of the situation are not being sufficiently discussed. There is a need to recognise this aspect and take it on board for a deeper analysis and remedy.

Clearly, the powers that be, the medical fraternity and civil society, must come to grips with the situation. These are, indeed, not the only imponderable issues needing far-more concerted attention. But they are important nonetheless. (MR, Inputs: Agencies).

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