Hon'ble Mr Ghulam Nabi Azad
Minister of Health & Family Welfare
Government of India
Chairman, Board of Governors, AIIMS
Nirman Bhavan, New Delhi.
It has been a shattering experience for me to visit the elite AIIMS hospital in June this year.
I had been there as an outpatient half a century ago, and I remember the dedication of the doctors and relaxed courtesy among most of them as well as their air of competent professionalism. No patient felt neglected or dissatisfied. That must have been a reflection of the politics of those days. Politicians in those days certainly were as drawn to power as their successors today, but that was also restrained by certain social norms as well as by the middle-class ethics of responsibility. The professional people, especially in public institutions, operated under that influence.
In the mid-1980s I had gone there again, and on that occasion noticed that a letter of introduction was necessary to ensure attention and care, but some sort of order, some semblance of decency was still visible, though fast coming apart.
In 1989, the counter closed half an hour before the scheduled hour without any apology or explanation to the long, waiting queue and a clerk noticing our disappointment and distress sneaked in and whispered possibility of consultation in return for a consideration. There was an obvious breakdown of discipline and morale under the insidious impact of commercialisation of public life and decent professional norms had gone under.
But this time in June 2010, I was in for a real shock. There must have been at least one lakh people -- mostly middle-class and country people, milling around desperately. There were dalals steering them around and they were hurrying from one corner to another seeking directions, asking questions there was no one to answer, and praying for an appointment with some specialist or other. There were people on the corridor, on makeshift beds who had been waiting for a week to meet a doctor. There were even beggar women with emaciated babies (obviously collected for the purpose) hoping to lure the unwary visitor into paying their supposed expenses. Exactly like a religious mela.
Before every counter there were crowds of harried people, and behind the counters angry, rude and bad-tempered receptionists who would not respond to questions from patients and visitors. The corridors looked dirty with cartons of material dumped on them, making passage a difficult business for the hurrying and harassed crowds. One had to walk long distances to move from one department to another in case tests had to be taken.
The doctors were perhaps professionally competent, but the interest in the patient's well-being that used to be the hallmark of the medical profession has disappeared. They probably think they are engaged in some charitable work against their will and to save themselves from overwhelming frustration seem to have developed an inhuman bureaucratic attitude. A most depressing spectacle. Obviously only people who could not afford better care visited AIIMS, and the doctors were hardly well-disposed towards such riff-raff.( There may be some exceptions. One cannot find out everything during a day-long visit.)
This was once the premier medical institution in the country, and is still considered the flagship of the entire Health Service under the government. Why has it been reduced to this wretched condition?
First, because there are expensive and well-equipped modern hospitals for the well-heeled, patronised even by media-persons, so the government does not hear much about the conditions in the AIIMS, except when there is a purely political ruckus. Secondly, it is a blatant indication that health-care is for the rich under the new dispensation in the country, and like rations for the BPL category AIIMS has become an hospital catering mainly to the down at heel in their tens of thousands who could not afford the posh hospitals. Hence the dirty, peeling walls, the congested corridors, and the lost look of the crowds of patients.
As with BPL groups it is mere tokenism as the staff and resources of one such hospital could hardly be enough to meet the needs of the numerous poor and the lower-middle-class. The shameful gaps in the capital between the rich and the poor could not be illustrated more graphically, and it could be a symbol for the entire country. (Of course there is a special section meant for the politically privileged, flaunting a VIP signboard, without crowds and with unhurried visitors. I wonder if a different set of doctors looks after them).
One question that springs at once to mind is why there is only one such super-specialty hospital for the poorer citizens of Delhi and surrounding regions, while they far outnumber the rich? When for commonwealth games thousands of crores can be spent, why cannot there be three or four, or may be more, such hospitals for the poorer citizens, breathing a less stuffy and bureaucratic air, and with a modicum of humanity towards the hapless patients?
How can the government pretend to be working for inclusive growth, when it cannot even ensure a reasonable standard of health-care, that too in the capital?
I do not expect a reply, for unresponsiveness is the defence mechanism of all institutions based on inequality and oppression.
Dr Hiren Gohain M.A.Ph.D(Camb)
251 231 Nizarapar Road