Indian Hospital

Indian Hospital: Episode 3

Can India become the first country in the world to disassociate healthcare from affluence?

This unique observational documentary series shines a light on Indian society as it is rarely seen. In six one-hour programmes it illuminates the complexities and dilemmas of modern India through the extraordinarily varied lives of patients and medical staff working at the Narayana Hrudayalaya Hospital Complex in Bangalore.

A series by Paul Roy.

Bangalore was once the sleepy capital of Karnataka State, southern India and a sought-after place to retire. Renowned for its numerous lakes, gardens and nice weather it is still referred to by many as the ‘Garden City’.

But the IT revolution of the last 10 years has changed all of that. Scores of major software and ancillary companies, both foreign and local, have set up shop in Bangalore – and now it is best known as India’s Silicon Valley.

The rapid growth and sprawl of Bangalore has brought with it an insatiable demand for manpower. Most end up living in slums or makeshift accommodation – with little hope of escape.

Nagraj is one such worker. He moved from his home village 10 years ago to a building site on the outskirts of Bangalore. He earns the equivalent of $12 a week working as a labourer. His wife, Lavita, and three children live with him in a two-room worker’s shed next to the building site.

For a family like Nagraj’s, which lives below the poverty line, the absence of a social welfare safety net means any ill health will cripple their finances and prospects.

Their eldest son, Bimesh, was born with a spinal deformity that has only worsened with age. Now 12 years old, his life expectancy is no better than the four million other Indian children who will die before they reach the age of 20.

Once a year, SPARSH, one of the four multi-speciality hospitals within the Narayana Hrudayalaya Health City, runs a charitable programme known as Sparsh Vachana, meaning ‘promise of a better life’. Under this scheme, the 1,000-bed facility provides free operations for up to 120 poor and underprivileged children.

Their latest scheme is focusing on orthopedic cases, like that of Bimesh.

The initial screening of 500 children for participation in the scheme takes place over three hectic days – and with the odds stacked 5-1 against selection, many are bound to be disappointed.

For India’s poor there is no fast fix and Bimesh and his family, along with the other 500 hopefuls, will just have to wait until a decision is made.

“In all the Western countries, government is the main giver, they take care of everything. In my country 80 per cent of the national expenditure on healthcare is born out of [the] pocket[s] of the citizens,” says Dr Devi Shetty, the founder of the Narayana Hrudayalaya Health City.

“Forty-seven per cent of the rural and 37 per cent of the urban population sell assets or borrow money to pay their medical bills. Medical bills are the commonest form of rural indebtedness. So in a country where government is a very, very small player we have to help one another, to look after our fellow citizens.”

As part of this philosophy of self-help and helping others, every month Narayana sends a medical team into rural areas to run screening camps for those who are too poor or unable to get to a hospital themselves.

In 2003, Shetty set up an innovative insurance scheme, which has given millions of poor farmers security in case of an accident.

“One of the co-operative societies of milk approached me to endorse a low fat milk as a good milk for people with [a] heart problem,” explains Shetty. “I told them I can endorse it provided they run a health insurance [scheme] for their milk vendors and this is how the Yashaswini Micro Health Insurance was born with the premium of 11 cents per month.

“In the first year we had 1.7 million farmers paying 11 cents a month and the government paid seven cents. There are 1,006 varieties of surgery done on the human body and all these operations are covered by this insurance. It became a big success – we have over three million farmers paying 22 cents …. Now we are helping six other state governments to launch this poor man’s health insurance programme.”

Shetty believes that India will become the first country in the world to disassociate healthcare from affluence.

That may be his dream but on the outskirts of Bangalore, 30-year-old Prabhu has not got years to wait. Already crippled with motor neurone disease, his life is about to take a turn for the worse.

Over the past six months Prabhu’s eyesight has deteriorated so much that he has been forced to leave his job at a local call centre. Dr Himanchu concludes that Prabhu needs cornea transplants for both his eyes.

With permission from Prabhu’s family, corneas will be taken from a recently deceased person. But in India religious concerns, such as not being able to see God after death, contribute to a huge scarcity of such donors.

According to Himanchu, there are two million patients waiting for corneal transplants in India with 40,000 new patients each year – of which only 20,000 get operated on.

And on this episode of Indian Hospital, we take a look at how at the heart of every hospital are its nurses – often unappreciated, undervalued and underpaid. Shetty has made it his mission to improve the lot of the Narayana Hrudayalaya nurses.

“If you want to elevate the standards of healthcare across the world, we have to elevate the standards of nursing care. Nurses are not just a pair of hands,” he says.

Shetty has introduced a radical and ambitious course for his nurses. Those that qualify after 12 months will be promoted to nurse intensivists – the same level as a junior doctor – so they can work independently of doctors.

He explains: “We would like all the nurses of this country to be elevated to the level of a doctor and all the doctors to become super specialists.”