We are all receivers as well as givers of care, acted upon as well as agents. This is a difficult position to understand politically, but strength and human cooperation can arise only from our recognition of our mutual interdependence
The Indian healthcare sector, mostly comprising Government hospitals, saves more lives, relieves more pain and suffering with available resources (India’s healthcare GDP percentage is 2.5 in contrast to 11.2 in Europe and 17.9 in North America) than any other country in the world. Yet, the sector has become a public punching bag. Care-related work has metamorphosed into a notion of seva, allowing room to curtail the rights of health workers (skilled and unskilled like the ASHA workers and the like) and their resistance is being labelled as “immoral.”
As per Joan Tronto’s theorisation of “care ethics”, it is an approach to personal, social, moral and political life that starts from the reality that all human beings need and receive care and also give care to others. Care relationships among humans are part of what mark us as human beings; we are always inter-dependent. In today’s context, we can argue that care work in India has been normalised as “voluntary.” A moral tone has been given to the highest skillful worker and the unskilled care-giver all alike.
In recent times, health and allied policies have resulted in a major restructuring of the healthcare system. However, the structural transformation most visible to us is the “privatisation” of healthcare, coupled with hardline nationalist language. If we trace history, we will see that changes during the first few decades after independence were at least at the level of planning and there was some commitment to public health. But by the 1990s, health investments were at the lowest and public-private partnerships took over.
Fundamental deficiencies of the country maintain status quo, which are the lack of provision for safe drinking water, sanitation, basic medical care along with lack of civic sense and ethical behaviour in “care receivers.” This is a reflection of the lack of attention to the state of healthcare in a country that touches millions of lives in the corridors of an over populated Government hospital, resulting in outbursts and breakdown of the health ecosystem at the grassroot level as well as in tertiary care centres. This unsettles the morale of healthcare professionals, who invest a whole decade or more acquiring degrees and experience and in the process, losing the larger picture of the society they belong to. Incidents of assaults on health practitioners demoralise them and degrade the noble profession of medical care giving.
It is understood that such intolerant behaviour is not seen in other professions like the police, who also deal with agitated people or one’s overwhelmed with emotions. This is simply because people are aware of the dire consequences of misbehaving with the trained individual who is equipped with arms and trained in legal affairs. Can the Government provide the doctors’ community with similar training? Can our policy-makers mandate a physical fitness training, push a law and create a legal cell for frontline medical staff? The other option, of course, is to provide a healthy environment in Government hospitals in spite of overcrowding so that doctors (and healthcare providers) can apply their minds to the best of their capability instead of staying alert, anticipating assaults and threats from a care-seeker from among the crowd that encircles him/her waiting around his/her table, jostling and pushing one another as they wait for their turn for treatment.
The social aspect of the state of affairs hindering medical care delivery calls for a public health approach around the perspective that provision of basic needs is the key to good health. And it includes sanitation, safe drinking water, right to treatment, security for care providers and mandatory good civic sense among care receivers at the hospital interface. A healthy working climate allows a practitioner to re-commit to caring, continue the profession’s tradition of arguing the dignity of people and shape the social climate within which they practise. A healthcare provider can become a powerful advocate for a climate of caring because of unique perspectives. A lack of it may lead to a collapse of healthcare services, pushing many to the death hole or complicate the state of diseases, leading to prolonged sufferings.
Social movements have also fuelled new problems, namely de-personalisation of the patients and violation of the right to self-determination, as witnessed in the disability rights movement, AIDS movement, queer movement and campaign against clinical trials among others. De-personalisation is reflected in all spheres of healthcare and in the context of Government hospitals — with corridors and doctors’ chambers choking with patients — there is hardly a culture of courtesy and social grace. In these over-populated set-ups, the first casualty is basic human empathy — all we get is brusqueness, negligence of ‘good’ manners or the right words, disregard for bed-side manner, which to a patient means bringing him/her hope and comfort to his/her recumbent or expiring patient. The much-needed bed-side manner is nothing but a sneering jibe in today’s state of healthcare system where every patient is eagerly awaiting his turn and competing with one another for the doctor’s attention when they are compelled to complete/accomplish care-giving with optimal use of time and exchange of words.
Patients argue that healthcare providers fail to recognise that illness and disability are states charged with personal meaning. Instead of communicating with patients, they often establish distance that diminishes them. They withhold information in a manner that precludes hope, use aloof manners and misuse powers. These discourage patients. Patients appreciate the care-provider to value interactive reasoning and thereby enact a climate of caring. It is important to realise that we are all receivers as well as givers of care, acted upon as well as agents. This is a difficult position to understand politically, but strength and human cooperation can arise only from our recognition of our mutual interdependence.
(The writer is a pathologist)