Standing in the hospital ward these days, I often think of the ruins of the Acropolis at Athens. The construction of the Parthenon, Propylaea, Erechtheion and the temple of Athena Nike, marked the pinnacle of the Greek civilisation. But today, mere ruins remain.
One afternoon, my colleagues informed me that 16-year-old Ram Pyari (name changed) had tested positive for COVID-19. She had a malignant tumour in her thigh and was admitted for surgery that had already been delayed because of the lockdown. The viral infection would further delay the lifesaving procedure. A junior doctor, who was involved in Ram Pyari’s care, remarked in exasperation, “When will we get freedom from this virus?” His outburst made me think.
Freedom is a nice word, but it can also have tricky connotations. As we celebrate freedom — the 74th Independence Day of the Republic — questions like the one raised by my colleague should make us introspect.
How important is freedom from the novel coronavirus? Of course, not all of us are waiting for a surgery to remove a malignant tumour. We are healthy, or at least we think we are. Most among us want freedom from COVID-19 so that we can go back to what we call a “normal” life. But for a large percentage of deprived Indian citizens, “normal”, actually remains undefined — it’s something they find difficult to think about. In contrast, some among us want the freedom to indulge in things we enjoy doing. An acquaintance, for instance, wants all malls to re-open so that he can go on his regular “de-stressing” shopping spree. Freedom thus means different things to different people. My freedom may not be the same as yours or that of Ram Pyari’s. However, the varying connotations of the word “freedom” do not matter with respect to a fundamental question: Is there a possibility of freedom from disease in this country of a billion-plus people?
In its 73 years of existence as an independent nation, the country has not given adequate importance to the health of its citizens. Healthcare has never been a priority for the state. More than a million children, less than five years of age, succumb to diseases like pneumonia and diarrhoea every year. The country’s infant mortality rate is worse than that of conflict zones like Iraq and Syria. In 2015-16 more mothers died in India during childbirth than in the rest of the Subcontinent — Pakistan, Bangladesh and Nepal did better than us in this respect. What does freedom mean for a woman for whom giving birth to a child is a life-threatening proposition?
Our commitment to the health components of the 17 Sustainable Development Goals (SDG) of the United Nations (UN) appears shaky. By 2030, the country will have to achieve the highest possible level of good health and well-being for its citizens. This requires everyone in the country to have access to quality healthcare services — no one should face financial hardship because of health reasons. This appears a near impossibility given the current state-of-affairs. A healthcare system in ruins — made stark by the COVID-19 pandemic — does not provide any semblance of hope for achieving the SDG goals.
Our annual expenditure on medical facilities says something about our commitment to healthcare — or the lack of it. State-spending on healthcare is little more than one per cent of the country’s GDP. This is way less than some of the world’s poorest nations —Ethiopia spends 4.9 per cent of its GDP on healthcare, Sudan spends more than 8 per cent.
As the philosopher Plato said, freedom in a democracy is the glory of the state. Unfortunately, of late, vested interests are trying to discover the glory of the state in reinventing the past, in stamping their domination and in pursuing an agenda of authoritarianism. All this at the cost of putting essential components of freedom like health and education on the back burner.
It seems cruel to criticise the country’s healthcare system when we are confronted by a pandemic. But it is essential that we continue to emphasise our freedoms — and believe in them — irrespective of the times we live in. Freedom from disease seems a far-fetched idea in India today. Many in the country consider disease a curse, a punishment for of an evil deed committed in the past — or present — life. People like Ram Pyari’s parents do not question the state for the non-availability of healthcare services in their remote village in Uttar Pradesh. They do not question the lack of good schooling for their four children. They also don’t question the non-availability of means to cure the bigger disease that perils their existence — poverty. And of course, they dare not question the institution of caste that makes them live at the fringe of their tiny hamlet. The basic premise of freedom is to question things that make our life difficult and raise red flags on issues that threaten our survival. For me, Ram Pyari does not live in a “free” India.
For the first time in our 73-year old history as an independent nation, we are staring at a crisis that threatens our health and also imperils our existence as free citizens. The pandemic has made us realise what it means to neglect the health of our people. The virus has tested our capacity to bear the pain that the country’s healthcare system has become in all these years. It has exposed the vulnerability of our healthcare models as well as the limitations of the political ideologies in the country.
It is up to us: Do we want to go back to the “normal” which we thought was normal or use this opportunity to understand the real meaning of freedom and create a new normal that is founded on the principle of equality. The ruins may seem beautiful but to live in ruins is not only scary but outright dangerous.
The writer is professor of orthopaedics, AIIMS, New Delhi. Views are personal
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