“I have seen filthy toilets, no water, shabby buildings practically falling apart, cobwebs, lab equipment and drugs strewn about [in India’s primary health centres],” shares Dr. Vandana Prasad, national convener for the Public Health Resource Network (PHRN), a voluntary network of public health practitioners striving to promote ‘Health for All’.
Over two decades of experience as a paediatric clinician, social activist and social worker in the field of public health, have given Dr. Prasad a wealth of knowledge about various aspects of the Indian healthcare system. She has also been associated with several health initiatives such as Right to Food Campaign and the People’s Health Movement (Jan Swasthya Abhiyaan), and has served as Member (Child Health), National Commission for Protection of Child Rights in the Indian government.
Youth Ki Awaaz recently caught up with Dr. Prasad at PHRN’s office in South Delhi for a conversation around her understanding of India’s public healthcare system and its shortcomings, and what needs to be done to turn the tide. Here are edited excerpts from the interview:
Nitya Sriram (NS): What got you interested in working with public healthcare?
Dr. Vandana Prasad (VP): So, I became a doctor to work in villages – that was the primary intent. But life takes you elsewhere. I went abroad and worked there. Then I decided enough was enough, came back, joined Mobile Crèches and worked with the children of construction workers for many years.
In the first two years, I realised that just working as a doctor doesn’t help anything. You’ve got to understand root causes and try and improve those. Otherwise, I would see the same children come back with the same issues – diarrhoea, malnutrition, and such. So, I learned from the ground up. Since then it’s been about trying to understand things politically, socially, as well as from a clinical understanding. Public health, as a discipline, lends itself to that kind of analysis.
NS: You said you have tried to understand things politically, socially, as well as clinically. What does this entail?
VP: For me, an understanding of class has been primary. Poverty, gender, power variables – essentially all our understanding goes around that. It’s quite simple – any thinking person sees the massive inequality in this country; there’s no level playing field. Things you and I take for granted – health and nutrition- are not available to all. The rate of progress has been very, very slow – things have improved but not the way they should have – not dramatically.
NS: What has your work experience with India’s healthcare system been like, so far?
VP: This work has been very inspiring. We’ve seen so many stories of courageous women who want to do well by their children. Many stories of change, where just minimum input, a single conversation, a little suggestion or demonstration, has changed people’s lives so dramatically. Also, there’s a prevalent attitude that poor people are uncaring and lower in capability, that they’re ignorant, not bothered. I have never got that feeling. I have seen tribal women spending so much money carrying a dead child to the hospital 400 km away just to see if anything can be done. You see these kinds of stories on a daily basis, yet the prevalent discourse is that poor people are dumb, uncaring, filthy, dirty.
NS: What is the general state of India’s Public Healthcare Centres? Can you give us an insight?
VP: I have done public health work in tribal areas, which involved working with the system, looking at the system. It is very variable. Every now and then you come across a beautifully functional PHC (Public Healthcare Centre) – I can recall some in Maharashtra, in particular. But on the whole, they are shabby, poorly looked after, poorly resourced, human resource situation is dire and mostly don’t have their full complement of doctors and staff. There are supply size issues with drugs and lab equipment, filthy waste management, very dangerous kind of waste around the place – glass bottles, expired drugs – it’s a very pathetic situation.
I have seen instances where doctor and pharmacist sleep in the same room as the OPD. I’ve seen filthy toilets, no water, shabby buildings practically falling apart, cobwebs, lab equipment and drugs strewn about. Imagine, you’re there for delivery, but you have to go to the jungle to relieve yourself when you’re suffering from labour pain. You’re looking for some quality assurance in these areas. But the kind of infrastructure has been rather stark.
NS: Can you recall what the worst PHC you came across was like?
VP: It was beyond pathetic. I felt like taking a jhaadoo (broom) and cleaning it myself! It consisted of one elderly doctor and one compounder living in one room. The other room was a kitchen-cum-lab kind of thing, covered in dust and cobwebs. That was it. They had about 50 people a day come to them every day, despite the condition, because it was a poorly served area in general. They had no bijli (electricity), no living quarters, no toilets, I don’t know what they did for paani (water).
NS: Any sights that have stayed with you long after?
VP: For one and half years, I worked with Kalavati Saran [Children’s Specialty Hospital]. I have seen a dead child and a living child in the same bed because there’s no place to take that dead child. They are just there, and the mother of the living child is sleeping under the bed.
On another bed, there’s a critically ill child and the family is taking turns on the ambu bags to make sure the child just lives. What else can you do? There are no ventilators. It’s a choice between doing that or letting the child die. The minute they fall asleep, their child dies. Awful.
NS: If there were five things you could change to improve India’s healthcare system, what would they be?
VP: We have to start with better investments, at least 5-6% of the GDP in the health sector (as opposed to the current 1%). I would really regulate the private healthcare sector and cut them down to size. I would make the facilities free at the interface, they should be funded from tax-based financing because there should be no scramble for money when you’re sick and dying. I would make the decentralised system we have today much more functional – the onus shouldn’t just be on hospitals like AIIMS and Safdarjung to provide accessible healthcare.
And yes, give better quality human resources. But what we need more than anything is a change in mindset. It is not an innovative or novel concept – Cuba has done it, Venezuela has done it, Brazil has done it. And for all of this we need a leadership, it requires an environment that is different from the current exploitative system that we belong to.
Did you know: Just by being washed in clean water and being cared for in a clean environment by caregivers who wash their hands, one in five babies who die within their first month, can be saved from untimely deaths. Yet, most of India’s public healthcare centres do not have access to clean water, adequate sanitation and proper hygiene practices (WASH). Let’s advocate for these basics in public healthcare centres across the nation by understanding the issue and asking our politicos to do more around it.