In one of the most backward blocks of Western Champaran, there's a certain Primary Health Centre (PHC) that highlights all that is wrong with the health sector in Bihar and in many ways, all over India. This particular PHC has two buildings -- one is newly constructed with a greater capacity for beds and better infrastructure, while the other is dilapidated and crumbling due to years of neglect. Sadly, the PHC still functions in the old building while the new one remains unused. A big lock hangs on the main gate of the newly built structure as it awaits some kind of a "deal" between the politically connected contractor and health officials at the block level.
Corruption is not uncommon in these corridors. From the disappearance of newly purchased medicines to small "cuts" from the salaries of front-line health workers, the aberrations of the system have become part of the daily tussle of running the entire machinery. Medical officers complain about the lack of doctors, health workers complain about the lack of timely payments, health managers complain about lack of human resources, district officials complain about lack of funds and so on. Amidst all the chaos and complaining, the patient is left out on his own, fending for himself despite the promises made by leaders at different levels of governance.
Horrible stories of deaths due to negligence and malpractice have become such a part of the folklore that people are afraid to go to [Primary Health Centres]...
Around 300km away from Western Champaran, in Patna, the capital of Bihar, one can find people from all parts of the state flocking for medical treatment. While some of them visit the overcrowded Patna Medical College and Hospital, most have to turn to private hospitals and clinics. In the city, localities such as Doctors' Colony in Kankarbagh have become a hub of private medical establishments and practitioners. These private clinics and hospitals, some of them run by quacks and medical assistants, are very competitive in nature, with each one vying to offer cheaper packages to allure vulnerable customers (read patients).
Most patients arrive here because the PHCs or district-level medical facilities in Bihar don't have specialists. Moreover, horrible stories of deaths due to negligence and malpractice have become such a part of the folklore that people are afraid to go to these facilities even when they are located nearby. Most of the rural poor, though facing an acute lack of resources, take loans or spend all their savings on medical treatment. After all, it's a matter of life or death for them. The greater tragedy occurs when these innocent patients are trapped by private hospitals that charge exorbitant amounts of money in return for very low-quality services. It's not uncommon for patients to come all the way from Siwan or Bettiah and die due to some form of medical negligence in one of these establishments.
Innocent patients are trapped by private hospitals that charge exorbitant amounts of money in return for very low-quality services.
Chandu, a man in his early 30s sits in one of these clinics with his son and wife by his side. He is from Samastipur where he works in a private establishment for a salary of ₹6000 a month. This is his third trip to Patna in as many months. His younger son, a two-year-old toddler, has a chronic pain in his stomach which doctors haven't been able to cure. "We first took him to the local hospital but they nearly killed him there. When his condition became critical we brought him here and admitted him to a private hospital. They kept him for a week and then discharged him. They never told us what the disease was, they just told us that he is fine and we could take him home. The pain returned within days and we had to come back. We came here again last month but weren't able to get an appointment with the big doctor. For this check up, I took an appointment 15 days ago over the phone."
When asked about the financial costs he is incurring, he told me, "What else to do? Can't let him die... I have been taking loans from my employer but it would be difficult for me to keep asking him for an advance every month." Chandu's story is a familiar one that echoes those of many of the 50 other patients sitting in this room, waiting for their number to be called out. The cost of treatment apart, just the expenses of travelling and spending a night in Patna take a toll.
Without an overhaul of the system, there is not much hope for millions of Biharis to lead a healthy, happy or stable life.
The lack of a functional healthcare system has a negative impact on the poor, affecting them economically as well as in the quality of life they lead. While new health schemes are framed everyday by the Centre as well as the state government, their effectiveness depends a lot on the quality of healthcare services that the prevalent structures can provide. The current state of these services has left people in the lurch, vulnerable to low-quality private medical establishments and quacks. Without an overhaul of the system, there is not much hope for millions of Biharis to lead a healthy, happy or stable life.
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