When Jaichand Desai (name changed) met with a motorcycle accident in February, little did he know that an injured kneecap would be the least of his worries. He lives in Peth village, in Dahanu taluka (Palghar district of Maharashtra), where the most favoured major public hospital is the Vinobha Bhave civil hospital in Silvassa (in the union territory of Dadra and Nagar Haveli).
On the day of the accident, a private ambulance said it would charge him Rs 18,000 for the 70-km drive. Since it was both exorbitant and unaffordable, he had to rely on a kind neighbour who drove him there for free. He had surgery for the damaged kneecap but when it was time for a follow-up in March, the COVID-19 lockdown had kicked in and he could not travel to the hospital.
People in these parts prefer the civil hospital in Silvassa, which, despite the rush, cares for people in the most humane way possible. It also ensures that all government benefits are given to patients. It has a team of experts who perform specialised operations. If Silvassa can manage to run a public hospital in a streamlined fashion, why can’t a large state with adequate funds, do the same thing? In fact, of late, the Silvassa hospital is also turning away patients not from its own area. The number of patients from Maharashtra is quite high and the reasons are not far to seek.
The closest hospital to Peth is the sub-district hospital at Kasa, 8 km away, which had to be shut down for a while after a doctor who had come there to set up the COVID ward fell ill. Even in non-COVID times, this hospital barely manages to function and is not exactly a go-to place, though thankfully, it has stocks of anti-venom which is much in demand. Recently, they sent a local journalist, who was admitted there with fever, to a private hospital in Dahanu for treatment after a week.
Meanwhile, Desai’s knee did not heal, and in June, he approached various hospitals, including a private one at Dhundhalwadi, only to be turned away. His X- rays, taken in a private hospital which had opened after months, in Boisar, showed that he would need another surgery costing Rs 1 lakh, which was too expensive. Finally, in the last week of June, he found a private hospital in Dahanu which agreed to perform the surgery for a smaller amount. Even for that, he had to borrow money. An employee in a private firm in Boisar, he has not been paid his salary since March.
In the face of the staggering hardships of migrants, and the overall grim picture of healthcare during the pandemic, this is not an unusual or even a dramatic story anymore. The people here leave healthcare to fate: If you are meant to die, you will. Travelling 150- odd km to Mumbai for public hospitals is something they rarely take a chance on, and the travel cost itself is prohibitive for many of them. Hardly anyone knows about the government health schemes and there is no one to explain things to them either. Many of the Warli Adivasis still prefer to have their children at home, while some have made it to the local sub-district hospital in recent times.
Though this area is close to Mumbai, these people do not have piped water or sanitation. People make a quick buck on mining water, and it is one of the ways of earning money. Healthcare is a low priority and that is why quacks abound, who make a successful living with their fake injections.
COVID-19 only exacerbated the problems of the abysmal healthcare infrastructure in the cities and rural areas. The emphasis on private healthcare has backfired in more ways than one. Most of the private hospitals have shut down since March in places like Palghar and Boisar and one of the few places that was open was the homoeopathic hospital run by the M L Dhawale Trust in Palghar. Suddenly, there was a flood of patients in the hospital, which scrambled around to raise funds to treat the hundreds of people who lined up for relief from non-COVID illnesses. Since it was run by a charitable trust, with a long and respectable tradition of healthcare, it could not be ruthless and turn away patients as the other hospitals did.
Some years ago, reporting on public hearings under the National Rural Health Mission, as part of an effort by the NGO Saathi and Nitin Jadhav, a doctor, and I visited the Saywan primary health centre (PHC) and other places in the Thane district. The PHC was leaking, there was water everywhere. The two toilets in the sub-district hospital in Shahpur were used as storerooms. A pregnant woman who had to walk a distance to reach another toilet, delivered en route and had to be rushed to a hospital to Thane city, three hours away. Radiologists and doctors are hard to come by even after the bifurcation of Thane into two districts, Palghar being the other one. In Shahpur, at one point a woman had to wait for the third Wednesday of each month for a sonography. The basic point is that despite all the grand government schemes, many of them involving much paperwork and red tape which can be a nightmare even for literate people, there is no universal healthcare worth the name in this country. Healthcare is almost geared for the highest bidder. If you have enough money, or if you can borrow enough, you can get by.
While some people are optimistic that COVID-19 is an opportunity to set right the healthcare system, nothing much will change even after the virus subsides. The same inequities will continue to prevail, with masks on. We are already practising social distancing in more ways than one.