It has been argued that big capital investment in West Bengal “creates a wonderful opportunity to make much larger investments in public education, healthcare, public transport, environmental protection, and other public goods.” (Amartya Sen, The Telegraph). On the other hand, the argument has been made that a government with a neo-liberal mindset does not care about people who, because of their purchasing power, are outside the market. If the government has money, it will make malls and flyovers, at the cost of public health. The problem is not one of intention but definition.
Facts seem to bear this out - for example, here’s a Prtichi Trust report on the state of healthcare in West Bengal: On the day of the survey, 7 of 18 health sub-centers were not working. Of 3 Block level health centers, one did not have facilities for testing blood, urine, or stool. 29% of the patients spoke of being treated by quacks. In Birbhum district, only 45% infants had been completely vaccinated, and 53% births had taken place outside any healthcare institution. (Work for everyone and Amartya Sen).
The striking statatistics below demonstrate that the market, left to itself, is unable to generate adequate incentives to address the health needs of the majority of the world’s population:
“Malaria, tuberculosis, and the strains of HIV common in Africa kill 5 million people each year, almost all of them in low-income countries. Effective vaccines against these diseases are desperately needed. Yet there is a striking dearth of research and development (R&D) on vaccines and treatments for diseases primarily affecting poor countries. Of the 1233 drugs licensed worldwide between 1975 and 1997, only 13 were for tropical diseases, and only 4 of those were specifically developed by commercial pharmaceutical firms to treat tropical diseases in humans. Half of all global health R&D in 1992 was undertaken by private industry, but of that, less than 5 percent was spent on diseases specific to poor countries”. - Kremer, M. (2004),
“On How to Improve World Health”, Daedalus, 133/3: 120-3.
Amidst all the statistics, local and international, it is perhaps instructive to look at a particular human story - the state of government healthcare for people who come at the very bottom of the purchasing market - the mentally challenged. The story is typical, and demonstrates the inhumanly dysfunctional nature of state healthcare that is forcing even the poorest to seek private institutions way beyond their means.
Mentally challenged female patients kept in a state of undress at Pavlov hospital, Kolkata
By Soma Mukhopadhyay. Translated by Soumya Guhathakurta, Sanhati
Where are her clothes? A question like this should not to be asked at Pavlov Hospital, Kolkata, because that is the norm at this institution for the mentally challenged. If you dare to ask, you will immediately face the wrath of the hospital’s employees union and have to apologise. You could be the hospital’s Superintendent - it doesn’t matter.
Situated at a distance of roughly 6 km from Writers Building, the administrative headquarters of the Left Front Government, this picture of a government hospital for the mentally challenged exhibits the inhuman state of affairs that healthcare really is in this Left Front ruled state. It is a typical picture.
The hospital has been in a state of turmoil since last Saturday (8th March, 2008) when a doctor on duty protested against this inhuman practice and as a consequence was insulted and then went on leave.
The sequence of events began on the morning of 8 March which, incidentally, is the International Womens’ Day. An 80 year old female inmate called Jibonprobha Mukhopadhyay’s condition deteriorated and her relatives were informed. On rushing to the hospital, the daughter and another relative of her’s were taken to the ward by the attending doctor, Dr. Ashish Acharya. A shocking scenario met their arrival - the 80 year old inmate, in a state of undress, was crawling across the ward to meet her visitors. The nakedness in the ward was all-pervading amongst inmates of various age groups. Everybody was naked. There were class IV employees going around the ward as well as other men in the ward for minor repair work. Jibonprobha’s daughter immediately covered her mother with a saree that she was carrying with her.
The other inmates broke down into sobs of despair and indignity. Sources in the hospital said that many inmates in the ward were at a level of mental alacrity at which they could feel the shame and indignity of being kept forcibly in a state of undress. Dr. Acharya protested about this inhuman practice and a row erupted.
Sources within the hospital said that, as a practice, inmates are kept in a state of undress till their clothes come back washed and dried. This inhuman method is often justified from the inmate’s safety and security point of view.
When the doctor lodged a protest, nurses and class IV employees demanded an explanation as to the reason for allowing the relatives of an inmate inside the ward. During the course of the argument the doctor asked a female employee how she would feel if she was treated in a similar manner. This offended the female employee and a group of employees brought a complaint against the doctor to the hospital Superintendent.
An official in the hospital said that the Super summoned the doctor as class IV employees declared that they would not work till the matter was settled. The doctor was threatened in front of the Super. Finally the Super, Arunendu Biswas, stood up and apologised on behalf of the doctor to the employees.
Dr. Ashish Acharya later said that he was in no way apologetic of his act and he did his duty as a doctor. He was not willing to make any other comment.
Is the practice of keeping inmates in a state of undress human? The nurses and class IV employees of the hospital were not willing to reply to this question.
Why are the inmates not clothed in another set when one set is sent for a wash? A nurse said that they in fact usually are, and perhaps there was a lapse on March 8. However, she also said that the matter was of minor consequence. Super Arunendu Biswas said that a complaint has indeed been received by him against Dr. Acharya but this was an internal matter of the hospital and he would not make any further comments on the issue. Are inmates of the hospital normally kept in a state of undress? The Super avoided answering the question.
There have been allegations in the past of inmates of Pavlov hospital being used to perform chores that ought to be normally done by class IV employees of the hospital. Unwillingness on the part of the inmates to do the chores invited physical beatings and other forms of intimidation.
In the recent past, a resident doctor was found dead in his quarters. The police recorded the case as one of suicide. A section of the doctors say that the deceased doctor was in a state of mental depression for sometime over the working environment in the hospital.
What do the West Bengal state government health authorities have to say after the March 8 incident at Pavlov hospital? Health offical Sanchita Bakshi commented that various incidents do occur at an institute for mental health. However, she was not aware about the incidents of March 8, and she would comment only after she makes an enquiry into the matter.
This article originally appeared in The Anandabazar Patrika
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