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Sufi Doctors and Nehru’s Ailing Centre of Excellence: Kaveri Gill

September 30, 2011

Guest post by KAVERI GILL

“AIIMS is like my aging mother, whose clothes are in tatters, and I feel I must hold them together to cover and protect her”. A senior anaesthetist said this the evening before I was due to have a relatively small but complex surgery, and my search for the best surgeon had bought me to the institute’s doorstep. Fifty five years after Nehru’s dream of a medical centre of excellence materialised, with state of the art teaching, world class research and high quality patient care, the All India Institute of Medical Sciences in Delhi is mostly in the news for all the wrong reasons: fracas over reservation, cheating on entrance exams and charges of  mismanagement.

And yet, conduct a quick informal survey amongst your social set (even those with endless willingness to pay) and you will find that most choose the hospital because it has the best doctors in the country, and the world. When you have a population of a billion to serve, with diseases that span all development phases, there is not much you have not seen and treated, more than once, under intense pressure. Of those who frequent private hospitals, many will disclose that the top specialist doctor they consulted has either trained or worked in the past at AIIMS. Clearly, the doctors are delivering despite the institution!

To an economist, health care is a commodity unlike others. One reason is that information asymmetry between patient and the doctor is heavily skewed.  My own brush with auto-immune illness in the last three years has demonstrated the truth of this in the way that no amount of abstract theorising could ever have done. I learned that it is a very bad idea to self-interpret diagnostic results (for ‘antibody counts’ and ‘positive serology’ mean nothing without clinical symptoms), and to Google one’s supposed condition (envisioning dire ‘Three Men in a Boat’ psychosomatic scenarios). As a social science doctor, I realized that a layperson’s “elementary, my dear Watson” deductions in the medical sphere were likely to be just that – rudimentary but also wrong. And I came to have a profound respect for doctors’ specialist training and knowledge – in India, five and a half years for an MBBS; another three for a MD or MS (equivalent in surgery); and yet another three years for a super-specialisation.

The other principal agent problem, of moral hazard and greedy private hospitals gaming the system for profit by ordering unnecessary laboratory and diagnostic tests, added considerably to the cost and fatigue of my unexpected illness. Such peculiarities of the health sector posit that even where the state is not directly the biggest provider of health care, it ought to play a large role in regulation of the sector. I leave the reader with the scary thought that if an educated patient with considerable agency had such an experience, imagine the plight of a poor and illiterate patient thrown at the mercy of an unregulated private sector.

The need for a surgery became apparent because doctors at AIIMS refused to accept the results of prior tests carried out elsewhere. A simple x-ray, carried out in a dilapidated and crowded but functional lab, immediately showed what had been missed by previous consultations, which meant I’d had high doses of unnecessary allopathic medicines for more than a year. My next task was to find a suitable surgeon. I turned to a surgeon who is a giant in a different field, and who in a patriotic and public-spirited act that was not unheard of at the time as it is today, returned from the best Ivy League schools and associated hospitals in the UK and US to India in the mid-70s, to work at AIIMS for over two decades. In the most scientific and yet empathetic manner possible (narrowed to number of surgeries performed by the doctor, type of surgery that my condition dictated, and estimated probability of risk in procedure versus benefit in prognosis), he helped me decide on an ex-student of his, someone who pursued his passion for staying abreast with cutting edge technological developments in his area by going abroad for further training, and is consequently now is the only surgeon in the country to conduct the newest robotic procedure. By now, it did not surprise me to find this surgeon works at AIIMS.

I met with him to set a date, only half-joking that my one request was not to be left alone with the robot. He was highly amused, and assured me that it isn’t an android. Instead, it refers to the use of console-operated ‘arms’, ‘wrists’ and a tiny camera, with an overhead LCD monitor, which allows magnification of the site with minimal invasion and no tremor. What in the old days would be an open surgery, involving scarring and a lengthy recovery time, are now three little punctures that disappear without a trace, and me writing this piece a few weeks after the operation. The machine is expensive, and hence shared, with it available only once a week. Patients from across Asia flock to this surgeon, who accommodated me as soon as possible after the repair and renovations of the OTs allowed.

My thoughts turned to the dismal findings of the latest report of the Parliamentary Standing Committee on Health and Family Welfare (2010), expressing “anguish” at the “procedural hassles” (a euphemism for botched up management, delayed approvals, suspect contractors and corruption) delaying “urgent developmental work” (including construction, OT/ICU/private ward refurbishment and purchase of high-end equipment) at AIIMS. Of 21 such projects envisaged for the 11th Plan, 14 are yet to start in its last year, and it’s not for a lack of money as unspent allocations are significant. No wonder I saw seriously ill patients, especially from the poorer strata of society, lying in the sweltering heat on campus pavements. It’s hard to take up cudgels with God on one’s own behalf in India, even with just cause, for the thought is quickly chased by evidence of how relatively lucky people from our class are in every situation.

The operation itself, without some drugs that were costlier, set me back Rs. 5000. Apart from the fact that this skill and procedure is not available at private hospitals in the capital and hence the question is moot, it would cost about Rs. 3 lakh if it were. To those who would argue that it is only privileged patients who get treated at AIIMS, it is a cynical misconception. My anaesthetist asked if she could keep the unopened remains of an expensive drug for a patient who might not be able to afford it, and my surgeon is waiting to operate on patients who are too underweight to withstand a surgery and cannot afford the diet to gain pounds. No doubt, those with our network links have speedier access to over-worked AIIMS doctors, but at least prohibitive cost does not keep out poorer patients, as it does at many top-quality private hospitals that are not empanelled for Rashtriya Swasthya Bima Yojana. Bravo for the Planning Commission’s expert health panel, which is currently resisting the government’s idea to impose user charges in public hospitals.

As the Committee observes, “pathetic working conditions” are cited by prominent doctors leaving the hospital as a major factor in the “acute shortage of manpower in recent times” at AIIMS. They withstand the lure of a 2 to 3 times larger salary (even post the 6th Pay Commission) offered by private competitors, only to succumb to the relief of working in more ordered, less rushed and better surroundings. Who can blame them, for even Sufi doctors who have spent years perfecting their art and patients (pun intended) have their limits, especially where dispiriting institutional failures prevent them from doing their job. A 2008 WHO Bulletin publication found that approximately half of AIIMS graduates during 1989-2000 reside outside India, and that graduates from premier institutions (within that exalted subset, the better doctors), account for a disproportionately large share of emigrating physicians.

The solution to this flight and brain drain is hardly to get them to sign bonds, as the Committee recommends, on the basis that the self-selected brightest in the country have received subsidised education. Rather, it is to boost retention by promising merit-based promotion, improving working conditions, as well as offering better housing and non-remunerative benefits. The other pressing need is to fix the pathetic supply side of doctors, fuelled by the dismal state of medical education in the country under the dysfunctional Medical Council of India (MCI), where places in state schools are far too few; a post-graduate seat in a private school costs approximately 1.7-2 crores, resulting in a perverse incentive to recoup this money by joining a highly-paid private hospital and gaming innocent patients after; and where private colleges of shoddy quality continue to flourish, despite shocking Tehelka exposes.

Sudhir Anand has recently analysed census data for the Planning Commission, to find that not only do we have less than half the doctors per head than China does, but half the so-called doctors do not have any medical degree. Are we relying on elite graduates of above mentioned money-spinners, some of which are fake institutions, to pick up the slack? It appears so. In 2003, the Pradhan Mantri Swasthya Suraksha Yojana valiantly promised to set up 6 “AIIMS-like institutions” across regions so as to reduce structural inequities in the availability of tertiary health care. In 2010, the Committee notes it will take “at least another Plan period” before these institutions are functional and they remain “a distant dream”.

Nehru realised his dream, while today’s India struggles to do so, despite two decades of sustained high growth. What galls my generation, which grew up in the age of pre-liberalisation restraint, is that we still see individuals who are as idealistic as ever. They may be a dying breed but they exist. I was humbled by my experience at AIIMS, for the highly-sophisticated in training but simple in demeanour Sufi doctors I met there embody old-fashioned qualities of a serious work ethic and service to society, honesty and putting others’ welfare before one’s own. For that is what it takes to survive working on the 8th Floor OT, with its spectacular views of Delhi but its adrenaline-pumping pressure, week in and week out for years. And yet the system consistently lets them down. I wonder, in a decade or two, will AIIMS even be what it is today? And something quite different to my operation wound hurts, for the death of a dream in a country I love.

(Kaveri Gill worked on public health at the Planning Commission, 2008-09.)

27 Comments leave one →
  1. Dr.Mohan Rao permalink
    September 30, 2011 7:07 PM

    Earlier this year I got a call from my parents’ family doctor in Bangalore – they still have one although the species is almost extinct. My mother he said needed to be admitted immediately for she had a heart block. She needed a pacemaker installed. Where should he admit her? 1. Apollo 2.Max 3.Trinity 4 Jayadeva.
    As a public health person, a doctor myself, I did not want her in either 1 or 2. I said either of the other two. in the event she was admitted to Jaya Deva Hospital.
    Its only on reaching the hospital the next day that I discovered this was a government super specialty hospital for cardiac care. The services were excellent. The doctors were all highly qualified and above all, very kind. All tests took place in the hospital. All medicines were provided in the hospital. Not once did anyone ask for a tip. the place was clean although not glitzy. They did have a shortage of nurses and orderlies. And I did see a lot of poor parents from all over the state and from neighbouring states being treated free.
    The Director said there was gardly any attrition among doctors but he did say there were huge shortfalls in nursing staff and Class IV. He said he would be delighted if my PhD students did a study there, comparing it to say Appollo.
    Cost here 107000. In Appollo the same procedure costs 6 lakhs. Talk of efiiciencies of the private sector. Similarly Caesaerean Section rates are 76 per cent in Appollo and 34 per cent in AIIMS. Efficiency?
    Yets why does Kaveri Gills’s Planning commission subsidise the private sector the way it does and starve the poublic sector and then say the public sector doies not work. Given what the government is doing to the public sector health system people are voting with their feet and going to the private sector. medical care costs are now the second largest cost of impoverishment in the country

  2. October 1, 2011 12:13 AM

    Good post. There are still a few extemely good and brave doctors in Govt Hospitals in India, but they would extinct soon if Govt policies do not change.

  3. Kabir permalink
    October 1, 2011 9:35 AM

    My doctor friends (those few who have stayed in India in government service) would love you for this. Many doctors in high-level institutions work in difficult conditions, and maintain high professional standards – its also a way of bringing structure against the chaos. One thought – the distinction between the work ethic and service ethic is key in policy – the latter much neglected / embattled in the reforms context, the focus being the former.

  4. K.Balasubrahmanyan permalink
    October 1, 2011 9:38 AM

    sad commentary bala

  5. Charakan permalink
    October 1, 2011 11:21 AM

    This is y I left Govt health Services

    http://malayalidoc.blogspot.com/2009/02/why-i-left-government-health-service.html

  6. Kaveri Gill permalink
    October 2, 2011 11:20 AM

    I agree with you, Dr. Mohan Rao. Sadly, it’s not my Planning Commission anymore and never was, I was just a small fry researcher. But I do believe good people on their expert health panel are putting across strong arguments for at least a few policies we’d like to see happen in the public health sphere in this country, and I hope they prevail before it’s too late. Kabir, thanks for your comment on work and service ethic, had never thought of these as distinct – especially in policy – but now that you’ve pointed it out, it makes complete sense.

  7. Chakra permalink
    October 2, 2011 3:24 PM

    Kaveri! Thanks for sharing some ‘hope’ and ‘faith’ in the times of cynicism.

  8. Dr. Nitin Negi permalink
    October 3, 2011 12:35 AM

    Nice presentation of the premier institute’s condition.Atleast there are few people in India who realise the dreaded fate of our health system in future……reading this article on 142nd birth anniversary of Gandhiji gives me a deep sense of regret about the paralysed health system in India..Seeing the plight of our country one can’t say that this is what our ancestors fought for!!!!!!!!!!!!

  9. Manish permalink
    October 3, 2011 4:17 PM

    Brilliant article. Your observation wondering why the others falied and fail to achieve what Nehru managed to is worth pondering. I, for one, atleast know where to flock to when I fall ill some day.

  10. Ravi Srivastava permalink
    October 3, 2011 5:08 PM

    Having been in and out of AIIMS for many years, for both my parents, for myself, and for others, and having seen usually good judgments and execution, and some botched ones, I wonder how AIIMs remains, along with a few other public hospitals in India, a place where patients of all sections of society come as a first resort, and not in the last resort. Something makes places like this click, probably as you say, the “sufi” doctors, who perform under admittedly difficult and stressful conditions, since there is much else that is deficient or wrong or could be improved – be it equipment, or the management systems or the recruitment practices, to name only a few.

  11. brijesh permalink
    October 3, 2011 7:14 PM

    me being a young doctor, know the plight of my fellows, in our post graduate training, we are made to follow orders from chief that a specific companys drug is to be prescribed or a so and so lab will take the test. THERE IS NO TEACHING mind you its TRUE, WE ARE ON OUR OWN TO LEARN, add to this the money they give, eg a 33 yrs old doctor who works in chennai under training for superspeciality in surgical oncology, gets 9000 rps per month and works from 7 am to 11:30 pm, dp i need to say more

    WE ARE ALSO HUMANS AND WE ALSO HAVE NEEDS AS OTHER PEOPLE. SOCIETY NEEDS TO UNDERSTAND THAT HOW MUCH BURDENED WE ARE. its all money game , it is out of greed of society that these PRIVATE HOSPITALS ARE HERE. DONT CALL US GODS BUT PLEASE TREAT US AS HUMANS

  12. Dr. Arnica D'Souza permalink
    October 4, 2011 7:58 AM

    A personal comment: D.M. Pediatric Neurology program started in India in 2003 with 2 seats per year. Only a handful of people have passed out. None has been absorbed as a faculty at AIIMS, despite having a super-specialty academic program for 8 residents being run by 1-2 faculty members only. WHY NO ONE WAS ABSORBED? Does AIIMS lack funds to pay salary of an assistant professor? Is there dearth of pediatric neuro-morbidity in a hospital which drains areas with very high rates of home delivery and neonatal brain injury. Even candidates with strong academic interest were forced out of the system. I have met a few of them, being interested in this specialty myself. An assortment of motivated, brilliant and enthusiastic young doctors with no future ! I am sure this must be the same as in other branches also, where people are forced to go to greed driven private sector. To the best of my knowledge, 1-2 who were very dedicated have joined other colleges, where they might not be able to practice the specialized skills they have built up and others are in private practice.

  13. Kaveri Gill permalink
    October 4, 2011 5:18 PM

    http://www.expressindia.com/latest-news/aiims-waters-down-norms-to-hire-specialists/855347/

    Please read the link to the Express Newsline story today, about how the grave writing on the wall is being chosen to be addressed by the powers that be. Personally speaking, I concur with all the medical doctor’s voices in the above comments (thanks for commenting, great learning for us laypeople), and with the opinion articulated by Ravi Srivastava (thanks, Ravi), and don’t think it’s a good idea to rely on people’s innate Sufi nature and goodwill, especially explicitly for policy purposes in the public health sphere, no? After all, we don’t expect that of many other professions, be they in the government or private sector, so why should we of medical doctors, a hard enough path in the first place. And is it so impossible to improve management practices, get equipment and infrastructure (when money is there), standardise recruitment and have merit-based promotion – in other words, just make it easier for committed doctors at AIIMS to stay on (and I do believe there are many there who are actually driven by the idea of public service), rather than leaving them no choice but to leave?

  14. October 12, 2011 1:27 PM

    While I appreciated the write up on how a state institution and particularly one in the health care sector delivers and believe that we should resist the privatization of health care seeing it as a right and not a privilege, the larger question that we should not lose sight of is who does the institution of the state actually deliver to? Fact is that as an institution AIIMS is simply unable to deliver justice to Dalits, there is more than ample evidence of blatant caste discrimination that is not being addressed in the context of this institution. The question is not one of just a ‘reservation fracas’ but of a deeply inbuilt structural inequality which is inbuilt into our education systems that is not being adequately resolved.

    Discourses on the ‘efficiency’ of a public institution like AIIMS should not avoid the question of caste discrimination but should effectively engage with it showing how the health care systems are not only available to all, but available in a way that empowers and dignifies.

  15. Kaveri Gill permalink
    October 12, 2011 6:46 PM

    Thanks for your comment, Philip, I guess reservation & other issues to do with caste discrimination was the elephant in the room as far as this piece was concerned (a conscious decision, as it was felt by mainstream papers who rejected it that it was too long as it is). While I am sympathetic to the cause in general and have in fact spent the last two days talking with senior scholars at the Indian Institute of Dalit Studies about social exclusion issues in education and other development spheres (not public health specifically), I’d like to respond to your entry point query first, i.e. “who does the institution of the state actually deliver to”?

    My answer is that AIIMS is doing far more to deliver justice to Dalits (even if imperfectly), by actually being open to and serving poorer patients (not exclusively Dalit, but as they’re over-represented in that category, many of them too), than any private hospitals in the country. It cannot have escaped your notice that where prohibitive cost is not keeping out patients from across wealth quintiles, private hospitals – even where they have been given government land precisely on the condition that they serve a certain percentage of the poor – manage to keep them out, de facto if not de jure (and hence, the Supreme Court has to give them a wrap on the knuckles every so often, the private hospital superficially responds by putting up public notices saying poorer patients are welcome etc, and then it’s back to business as usual, with the use of social markers like dress etc used to filter out those from disadvantaged backgrounds). I’ve just returned from AIIMS in the last half hour, ironically walked past the BR Ambedkar building and seen the range of patients the like of which you will never see in a pvt hospital in India, not even close. Please validate that for yourself.

    So, contrary to what you imply in the second paragraph, this piece does not touch on “efficiency” at all, only “equity” i.e. access to quality tertiary health care services for a much wider cross-section of society, including Dalits, at AIIMS, but also, regionally, had the 6 AIIMS-like institutions actually been up and running, as they were meant to be. And I think the question of “who does the institution of the state deliver to” can only be adequately assessed in relation to the answer to the question of “who does the institution of the market / private sector deliver to (or not)” – you might not be comfortable with what you conclude at all, that the state empowers and dignifies, if imperfectly, where the private sector fails entirely!

  16. October 12, 2011 9:27 PM

    Kaveri, thanks for this response. However, what I was pointing to is that the framing of the debate in terms of private vs. public health care obfuscates the the issue. There is no denying that health care should remain in the public sphere, I am totally with you on that one. However, my contention is with the valorizing of an institution that is so deeply embroiled in caste discrimination of the worst order. Of course Dalits who go there as patients will be taken care of, and will be taken care of well, the layers of power relations between doctor and patient remain intact when this happens. The question really is, what happens with AIIMS as a teaching institution where the relationship between the control over (higher) education and caste dominance is ruptured by affirmative action thereby opening up spaces for Dalits and Adivasis which would never have been earlier present. It is here that AIIMS fails miserably, the deeply ingrained caste discrimination that is inherent in the institution comes to the foreground when Dalits and Adivasis take their place along side other doctors as their colleagues and not their patients. It is this discomfort which makes caste violence prevalent in AIIMS, separate dining spaces, harassment of Dalit students, writing obscenities on their doors… I am sure you know the list

    I am sure that you will agree with me that an institution such as AIIMS should bear the function of not only health care for all but in the correction of social inequalities which exacerbate health care issues. Unless AIIMS is willing to address this glaring issue, an elephant in the room, as you refer to it, I would say it not only fails as an institution but must be condemned as being part of a complex that perpetuates social hierarchies.

    • brijesh permalink
      October 16, 2011 2:06 PM

      well i dont know whether to laugh or cry over what philip has written over caste issue, THE PROBLEM IS NOT WHAT AIIMS IS DOING, problem is what OUR POLICYMAKERS DID 60 YEARS BACK WHEN THEY GAVE RESERVATION BASED ON CASTE, WHEN WILL PEOPLE UNDERSTAND THAT CASTE BASED RESERVATION IS NOT HELPING DALITS,NOT AADIVASIS AND NOT NATION AS A WHOLE, INSTEAD IT HAS MADE MATTERS WORSE FOR THE NATION,it has only benefitted politicians and so called dalit netas who are least concerned about NATION. we as so called upper class people have no problem at all to live eat and indulge with any person as long as IT IS MERIT BASED.
      so please open ur eyes , expand your thinking and SEE THE REAL PROBLEM

  17. Kaveri Gill permalink
    October 12, 2011 11:10 PM

    Thanks, Philip, I actually don’t think that a main function of AIIMS is “…..in the correction of social inequalities which exacerbate health care issues”. At least, no more so than every single institution, private and public, and every single individual, that is complicit in this historical wrong in our country.

    The irony of your statement that, “Of course Dalits who go there as patients will be taken care of, and will be taken care of well” cannot be lost on you – based on my experience, of private and public hospitals in the city and in remote districts of India, there is no comforting “of course” that prefaces this statement, so in making this claim, and voicing this expectation of AIIMS based on your own experience, you might be guilty of inadvertently valorizing the institution, too!

    Framing the debate in terms of private versus public health care does not obfuscate the issue that was the focus of my piece i.e. access to quality tertiary health care for all. To my mind, if no private hospitals and few public ones serve the poor in the first place, the secondary issue of whether there is greater discrimination against a certain excluded subset of the poor (that, too, on the supply side of doctor teaching and hiring, rather than the demand side of the patient, and when AIIMS fares relatively better than a host of institutions on the latter, by your own admission) is a moot point. Re-phrasing your comment, if in the absence of AIIMS, de facto there is no (quality tertiary) health care system, then the question of social inequalities exacerbating something that’s dead in the water doesn’t arise. For this reason, I did not get into the caste issue for I didn’t want it to drown out my core argument.

    Finally, on the issue of reservation, Prof Thorat and other experts have written about the complexities of social exclusion and discrimination, even with reservation – for eg., student suicides and so on. I will only say that it is not any one institution that can be blamed for the many horrors that persist (and persist they do, I agree with you), rather our entire society and every individual in it that remains implicated at many different levels (to think otherwise is to be blissfully simple-minded). For this reason, it would be sheer idiocy to go after the single premier specialist teaching and training public health institution on these grounds (does the political class do so, only because in many different ways, it is easier to target than the private sector / other hospitals? Why don’t we see private hospitals, even empanelled ones, being compelled to admit patients from poorer strata of society, as they’re required to do if they get govt. land? The media writes about it every day, but nothing is done about it).

    To condemn AIIMS and run it to the ground on the basis of your argument is also shooting oneself in the foot – at least, if getting access to quality tertiary health care for all, including Dalits, is your main agenda. And shouldn’t it be? After all, health care is a fundamental right for all human beings on this planet, in my worldview anyway.

  18. October 13, 2011 11:14 AM

    Kaveri, thanks for the immediacy of your responses and the debate that is emerging between us out of this. Just four quick points.

    First, on whether it is fair to single out AIIMS? I would argue yes for two reasons, firstly AIIMS has been on the agenda of Dalit Movements for a while as a symbolic epitome of what is wrong with Indian education. secondly it is mind boggling that blatant caste discrimination would be such a part and parcel (and institutionally supported) of a premier education institution like AIIMS.

    Secondly AIIMS should have the function of leveling social inequalities not just because it is an institution of the state but also and more importantly because it is an educational institution. However like I tell my students, what goes on in AIIMS is ample evidence to show that education does not lead to liberation, the question really being of the nature of education that is imparted, which then leads us to ask what exactly is being taught at AIIMS that permits such blatant discrimination?

    Thirdly, I think that the real irony lies in the fact that AIIMS has no issues with Dalit patients but with admitting Dalit students. The irony is multi-layered here as it involves notions of purity, pollution, closeness to organic life, what is considered to be traditional occupations and what happens when these become profitable both in terms of the economy or in terms of status as well as how Dalit patients in AIIMS do not upset the status quo, but having Dalit students and Dalit doctors does. Significantly this is what we are finding true in society in general, violent backlashes against Dalits occur not merely because they are Dalits but when Dalits make attempts to break the status quo.

    Lastly I am not calling for the abolishing of AIIMS far from it, but rather for two things, first that the severity of caste based discrimination (and not just ‘reservation politics’) be recognized in AIIMS, which I am afraid is what your piece failed to do and which is why I responded in the first place. And secondly that this discrimination be addressed in a way that not only brings justice to its victims but that AIIMS becomes an institution that secures Dalit rights, and not just the right to health, but also the right to education, the right to security and the right to dignity.

  19. Kaveri Gill permalink
    October 13, 2011 7:17 PM

    Thanks, Philip, I think as I’ve defended why my piece fails to look at questions you want to put centre-stage twice over and quite comprehensively, there’s no need for me to do so again. My primary concern here is the right to health, and access for all, in particular, to tertiary care. If you want to focus on caste-based discrimination in education and hiring in institutions in India in general, inter alia at AIIMS, too, I suggest you write your own piece for Kafila, rather than endlessly commenting on mine and forcing me to reconsider what I ought to have chosen to focus on, purely because it is about AIIMS!

    I’ll end with two thoughts – one, you might wish to begin your own piece with the contrariness of your first two statements, that AIIMS is the focus of Dalit movements as a symbol of what is wrong with the Indian education system, even as in the next breath you argue it’s mind-boggling that such a “premier education institution” is riddled with caste discrimination. So what is it to be in your view, on balance, a stellar education institution or not? In my worldview, it absolutely is – without a doubt – a world class education institution, if judged by the quality of doctors it produces, as a teaching, publishing and practicing hospital institution ought to be judged).

    Two, you prove the sad adage that in our country we like to hold institutions that are operating and operating better than their peers – on equity, might I stress, not efficiency – to far higher standards, and tear them down if they don’t meet every last criteria. On the other hand, there are other institutions (here, both private hospitals and other public hospitals) that don’t even have to begin to meet a base minimum of standards – on equity, to reiterate, so not on admitting & Dalit patients, let alone hiring them as doctors – and yet we leave them well alone. Maybe it takes too much effort and soul-searching, but it’s an indictment of our thinking and our so-called social movements to act in such a bloody-minded and obstructionist way, for it’s surely to the severe detriment of our country in the medium and long-term, most especially to the very groups whose interests you claim to represent. That’s my view only, I don’t claim to speak for anyone else.

    And I look forward to reading your piece on caste-discrmination in education and hiring in India, in Kafila or elsewhere, as I resent any more hijacking and obfuscating of my core concern and focus in this piece, both as a researcher and as a patient, which – for the last time – is the right to (quality tertiary) health care for all.

  20. Kaveri Gill permalink
    October 17, 2011 6:25 PM

    Brijesh, your comment has just come in, but as I explained to Philip, I will also appeal to you to please refrain from using this piece to comment on the rights and wrongs of reservation (please have that debate elsewhere). This is precisely the kind of diversion I wanted to avoid, as it eclipses the dismal state of tertiary health care in our country, which is my paramount concern and which is what drove me to write this op-ed.

  21. Harsh Kumar permalink
    October 22, 2011 8:59 PM

    Kaveri,
    Nice to see such an article written with truth and passion. Greater joy is in seeing a carefree girl of SRCC taking the social issues with amazing depth and alacrity. We need more straight-thinking people like you in our ‘intellectual institutes’…
    Harsh

  22. Kaveri Gill permalink
    November 14, 2011 2:30 PM

    http://www.indianexpress.com/news/Specialists–crunch–24-7-health-centres-a-distant-dream/875373/

    To read, today’s “Specialists’ crunch: 24/7 health centres a distant dream.” Why must there be so many “distant dreams” in public health care in India, especially in high-focus poorer states, as we are on the threshold of the XIIth Plan? What this article doesn’t mention is that because of a binding supply constraint, in states like Bihar, all specialist positions at CHCs are subcontracted out, too! This is why the Medical Council of India and other responsible bodies need to sit up and assess the state of medical education in the country urgently, overall but with added measures / incentives to serve rural populations as well. And of course, to get that other “distant dream”, of the regional AIIMS institutions, into some kind of pragmatic focus and reality, rather than yet another eternal chimera in the social development and justice sphere.

  23. Kaveri Gill permalink
    December 14, 2011 10:25 AM

    Here is an update on the requirement versus the reality of private hospitals giving free treatment to economically weaker sections (EWS), circulated by a member of the monitoring committee of the Delhi govt.:

    “Delhi Government constituted Monitoring Committee of which I am a member has inspected Maharaja Agarsen Hosital, Punjabi Bagh and Sir Ganga Ram Hospital, Karol Bagh on Saturday 10.12.2011. At the time of inspection, only six EWS patients against 38 EWS beds were admitted in Maharaja Agarsen Hospital. All these six EWS patients were referred by the Government Hospitals. The Committee advised the hospital to appoint a social worker to increase the number of patients in the I.P.D. and O.P.D under free category. In Sir Ganga Ram Hospital, the Committee found that 65 EWS patients against 68 EWS beds were admitted. The Committee observed, “Sir Ganga Ram Hospital in general is doing a good job for the EWS patients and the Nodal Officer in particular is doing an excellent job. The Monitoring Committee expects that the good work is continued.”

    During the inspections, it has been observed that barring very few hospitals, all other hospitals are reluctant to provide free treatment to EWS patients. In one of the recent cases, a EWS patient was referred by Hindu Rao Hospital to Sunder Lal Charitable Hospital, Ashok Vihar for free treatment but the Hospital denied treatment on the pretext that the patient did not have BPL card (BPL card is not a legal requirement. What required is that the family income should not more than Rs.6422/- per month and the patient or his or her relative has to simply declare it on the declaration form required to be supplied by the Hospital. In case, a patient is referred to private hospital for free treatment by a government hospital, the government hospital gets such declaration filled up and send it to private hospital along with the patient). Sunder Lal Hospital by denying free treatment to the patient has committed contempt of the Hon’ble High Court and a petition in this regard would be filed soon by the Social Jurist, A Civil Rights Group on whose petition the High Court issued directives for providing totally free treatment to the EWS patients by all the 43 identified private hospitals to the extent of 10 IPD & 25 % OPD. There are around 800 free beds in these 43 private hospitals with state of art facilities which need to be optimally utilized for the benefit of the poor of this country”.

  24. Kaveri Gill permalink
    July 3, 2012 6:38 PM

    To Philip Vinod Peacock and others who wanted to discuss this issue on this post – here’s a piece of amazing reportage that makes you want to cry, and perhaps one should, for as a country we have so far to go in so many ways and the odds are so stacked against some marginalised communities and individuals, that it seems almost hopeless at times:

    http://www.caravanmagazine.in/Story.aspx?Storyid=1468&StoryStyle=FullStory

    Talk about a systemic failure, of those in positions of power and responsibility, ensuring that future generations will also rumble along as inequitably as they did in the past, perhaps be even worse off, and entire institutions will be a shell of what they used to be, in every way. The faculty, management and administration are wholly responsible in so far as students will follow their lead, there should be absolutely no discrimination allowed under their watch, that isn’t addressed by immediate punitive measures against transgressions. This step alone would ensure that any latent prejudice that is harboured – amongst new entrants and old members – is kept in check. Is that too much to ask? In 2012?? Clearly. That’s why it’s a case of ‘Cry, the Beloved Country’, despair at where we’re at, in the 21st century.

  25. Pritam Singh permalink
    November 6, 2012 3:16 AM

    Thanks Kaveri for sharing this- it is good to know that there still are public spirited doctors in public sector hospitals.

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