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From Service to Industry: Witnessing the Decline of India's Public Hospital System

July 16, 2013 | Pulitzer Center
By
Jonathan Cox, for the Pulitzer Center

Nurses distribute free cough syrup and other basic medicines at an Aarogyasri camp in Kandur. The camp is run by several private and government hospitals from Hyderabad who distribute medication, write referrals, and perform basic check-ups for the 1,000-odd villagers who attend. The camps take place twice a month in each district, with the aim of educating rural families, many of them illiterate, about the availability of public health insurance — a luxury unimaginable just six years ago. As knowledge of the program spreads through word of mouth, the number of villagers who attend has grown steadily. Image by Jonathan Cox. India, 2013.

Farmers from the village of Kandur walk toward the Kandur camp at the district high school. Image by Jonathan Cox. India, 2013.

D.S. Thakur (in pink), the marketing manager for Aarogyasri, defends the program against villagers who claim that it is a publicity stunt which provides no help for the conditions they deal with on a day-to-day basis. “Any patient with a white ration card can take treatment for absolutely free,” he assures them. Image by Jonathan Cox. India, 2013.

“All that is on Earth is sure to perish” reads the melancholy plaque outside the in-patient wards of Osmania General Hospital. As a historical heritage site striving to provide modern medical care, Osmania has suffered from a lack of funding and a slow-moving bureaucracy which makes even simple repairs difficult. The Chief Minister, Kiran Kumar Reddy, gave his approval in 2010 for the demolition of other “dilapidated” buildings in the Osmania complex, as well as construction of a $40 million new building, but three years have passed without result. Image by Jonathan Cox. India, 2013.

Patients, in separate lines for men and women, wait to file for appointments in the out-patient wing of Osmania General Hospital. Over 1,000 out-patients visit the hospital on a daily basis. Image by Jonathan Cox. India, 2013.

Shoes sit outside one of the ICUs, but this meager attempt at hygiene in the wards is not enough. In 2012, 18 children died of sepsis in one of the wards, which was long past-due for fumigation. Image by Jonathan Cox. India, 2013.

A common sight in the hallways of the out-patient wing of Osmania. With extremely limited equipment and staff, a patient’s stay can stretch out indefinitely. Many, like this man, bring food, water, and simple bedding, and settle down to wait for hours, and sometimes days, for treatment. Image by Jonathan Cox. India, 2013.

Frequent power cuts add to the difficulties of patients and staff of Osmania. With back-up generators for only the most vital equipment, the in-patient wards can be plunged into darkness at a moment’s notice. Image by Jonathan Cox. India, 2013.

Families store their belongings on the gate leading into the out-patient wing. Image by Jonathan Cox. India, 2013.

As a government hospital, Osmania is technically required to provide all necessary care—including medication, which is responsible for the bulk of out-of-pocket pay in the country—free of charge. In practice, over 200 patients go to one of these nearby pharmacies daily to buy medication, says the owner, Mohammed Shafir. Image by Jonathan Cox. India, 2013.

G. Vidatya (on left) and K. Vidatya stand outside the emergency operation theatre. K. Vidatya is the chairman of the A.P. Junior Doctors’ Joint Action Committee, an organization which lobbies for doctors’ rights and has been at the forefront of the dispute over funding for Osmania. Image by Jonathan Cox. India, 2013.

Draped in unwashed plastic is one of the many primitive and unwieldy operating tables used by Osmania’s doctors. “Some of these have collapsed, even during operations, but the government will not purchase new ones,” says K. Vidatya. Image by Jonathan Cox. India, 2013.

Relatives of patients wait for X-rays. Osmania has a perennial shortage of scanning equipment. One of its CT scanners has been broken since January, while the other has arrived but has not been unboxed in over a month because of disputes over its placement, says Dr. Jafar Hashmi, head of the Aarogyasri Dept. of Osmania. Image by Jonathan Cox. India, 2013.

One of the 108 ambulances, a “hospital on wheels” equipped with sophisticated life-support equipment and GPS. But government disputes and delayed payments have left the ambulances stuck in their garages on multiple occasions. Image by Jonathan Cox. India, 2013.

A new ceiling, new curtains, and new air conditioners: these are the improvements made to the emergency post-op ward in Osmania Hospital, while only one in five beds has access to a monitor, and fewer to a ventilator. “The government wants it to look like a private hospital. They don’t care so much whether or not the necessary equipment is there,” says K. Vidatya. Image by Jonathan Cox. India, 2013.

“Those alone live who live for others. The rest are more dead than alive” reads a poster above the entry to the main corridor in the op ward of Osmania. The Indian government used to term healthcare a “service,” but it has recently been re-branded as an “industry” and the understanding of healthcare has changed accordingly to emphasize profit over care, says Dr. Vijay Kumar, director of a civil society organization based in Nellore. Image by Jonathan Cox. India, 2013.

Hyderabad is a boom town, thriving on wealth generated by the IT sector. The names of wealthy neighborhoods — Paradise, Jubilee Hills, HiTech City — all suggest that the good life in the city is very good indeed.

But the IT boom has not lifted all boats. Nowhere is this more evident than the healthcare sector, where private hospitals benefit from government land grants and public insurance programs, while public hospitals struggle simply to keep their wards lit. Many poor families choose to go into debt rather than go to a public hospital, and this debt is one of the top causes of poverty in the region.

“Health is the birthright of every citizen” says C.G. Raghuram, chief anesthesiologist at Osmania Hospital, but it is a birthright often denied to the poorest of the poor.