Bangalore: To get the best care,” Robin Steeles said gamely, “you gotta pay for it.”
Steeles, 60, a car dealer from Alabama, had flown halfway around the world last month to save his heart, at a price he could pay. He had a mitral valve repaired at the state-of-the-art private Wockhardt hospital here, and for 10 days recuperated in a carpeted, wood-panelled room with a view of a leafy green courtyard.
A dietician helped select his meals. A dermatologist came as soon as he complained of an itch. His Royal Suite had cable TV, a computer and a mini-refrigerator, where an attendant stashed some ice cream for when he felt hungry later. Three days after surgery, he was sitting in a chair, smiling, chattering, thrilled to be alive.
On his bed lay the morning’s paper. Dominating its front page was the story of other men, many of them day labourers who laid bricks and mixed cement for Bangalore’s construction boom, who had fallen gravely ill after drinking illegally brewed liquor. More than 150 died that week, here and in neighbouring Tamil Nadu. Not for them the care of India’s best private hospitals. They had been wheeled in by wives and brothers to the overstretched government-run Bowring Hospital, on the other side of town. Bowring had no intensive care unit, no ventilators, no dialysis machine. Wockhardt has 30 ventilators.
At Bowring, one of the young doctors, Harish, said a ventilator and a dialysis machine would have allowed him to keep half of his patients alive. The most severe case, Mohammed Amin, was breathing with the aid of a hand pump that his wife squeezed silently.
Where you stand on the Indian social ladder shapes to a large degree what kind of health you’re in, and what kind of health care you receive. The beds in Bowring were taken up by small, skinny men. One of Wockhardt’s most popular offerings is a weight-loss programme, and the majority of walk-ins at its outpatient clinic suffer from diabetes, closely linked to obesity.
This is no anomaly. A recent government-sponsored National Family Health Survey says a woman born in the poorest 20% of the population is more than twice as likely to be underweight than one in the richest quintile, and 50% more likely to be anaemic. For children, the gap is as stark. The poorest quintile is more than twice as likely to be stunted, due to chronic malnutrition, and nearly three times less likely to be immunized.
The survey found two-thirds of Indian households rely on private medical care, a preference that cuts across class. Asked why they don’t use public facilities, the most common answer was poor care. India has a countrywide network of government-funded primary health centres and hospitals, but staffing, medicines and resources vary widely. Some, especially in rural India, are notorious for having staff doctors on paper at best. This is only beginning to change. The government has increased health spending in recent years, and this year began a health insurance programme that would allow people in poverty access to a hospital of their choice.
The morning papers did not let Steeles forget the vast gulf between his predicament and that of the hooch drinkers fighting for life at Bowring. Yet as far apart as they were, their tales followed a somewhat parallel plot. The American health care system could no more care for Steeles than the Indian system could for Amin.
Steeles came here because he is uninsured, and could not afford surgery in the US, he said, without liquidating most of his assets. After five months of research and emails to doctors worldwide, he chose a surgeon here in Bangalore. All told, he said it cost him about $20,000 (Rs8.5 lakh), one-tenth of what he would have paid at a private American hospital.
Across town, among the hooch drinkers, a few of the worst cases had been transferred to private hospitals that had agreed to take them, at the government’s expense.
© 2008/THE NEW YORK TIMES