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Pick battles big enough to matter, small enough to win.
- BM Hegde (17 September 2007)
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A Surgeon`s Tale
- Debashis Bhattacharya (17 September 2007)
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BM Hegde, Retd Vice Chancellor Mangalore 575 004, India
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Dear Editor, BMJ has been in the forefront of telling people many unpleasant truths. Health of society has nothing to do with the hospitals and doctors. Planners, rulers, civil engineers, and administrators have a greater role to play. Why are we not doing as much as we should be doing in the filed of health maintenance? The answer is very simple. Why are there so many studies and so much activity in the area of curative medical care? “Fix it,” and “do it,” are the mottos. There are very important stakeholders in that area who have been pushing the agenda almost continuously. These people will stand to lose if society becomes healthy. They are not foolish to break their rice-bowl! Business always looks for profit. Just as the defense industry wants wars everywhere, drug industry would want diseases to sell their products. Disease mongering has become “scientific” (most respectable word) these days. Poverty should be the best friend of the industry as it is the womb of all diseases from cancer to common cold. To give an example, childhood malnutrition in India is still at a staggering figure. It was 47% in the 1993 survey. The 2006 survey showed that to be still 46%. This is much more than sub-Saharan Africa. Of course, India being a large continent, there are pockets of excellence in some parts. Very high levels of malnutrition prevail in many other parts. However, the fact remains that no one is seriously pushing the agenda to correct this appalling situation except by paying periodic lip service. Control of some communicable diseases has brought down the infant and childhood mortality figures to comfortably low levels in the 2007 UNICEF survey in India and China. If the overzealous push given to vaccinate the poor kids were to be preceded by the same zeal to improve their nutrition, we would have eradicated many diseases in addition to small pox by now. Vaccine industry is very powerful while there is no poverty eradication industry anywhere! India is a developing super power. The GDP is going up by the day. Rich have become richer and the poor the poorer. There are more millionaires in India today than in the USA! Top end hi-tech private hospitals mushroom all over and are doing very good business. Each of them gets many sops from the government. They proclaim from housetops that they exist to help the poor! Hardly any poor person gets help from those hospitals despite the fact that they are obligated to serve the poor in lieu of the many sops they get from the government. All that remains on paper. The ground reality is that only the rich and the powerful get serviced. They are talking and working on the lucrative “health” tourism. However, no one bothers about the poor health status of the majority of citizens. May be in the NHS primary health providers, the GPs, might help keep the health of the population, but in India even that is impossible. We need universal literacy and mother’s education not only for eradicating childhood malnutrition but also to reduce the birth rate. The poorest of the poor require six important things to improve their health in our country, viz: clean drinking water, three meals a day uncontaminated by human and/or animal excreta, toilet facilities for every one to avoid the ravages of hookworms, a roof on their top in place of the star-lit sky, avoidance of cooking smoke, full of carbon monoxide, remaining inside the house when people cook with fire using dry leaves, twigs and dried cow dung cake and, finally, economic empowerment of village ladies. All these could be easily accomplished if only we have the political will and the administrative commitment, both of which seem to be lacking. Unfortunately, the improved status of the poor might not be advantageous to the politicians during the next election as eradicating poverty is their staple diet for every election campaign. It should thus be clear to any one fighting to eradicate poverty and to improve public health that they are up against a mighty “great wall.” Yours ever, bmhegde Competing interests: None declared |
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Debashis Bhattacharya, Specialist Registrar, General Surgery North Western Deanery
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This is to welcome and support Mr.Keogh and Lord Darzi`s inclusion in the team of wise men to improve the primary healthcare structure. The old adage can now give way to a new aphorism "A surgeon is a physician who can operate". Essentially, it underlies the importance of good history taking, clinical examination, analysing appropriately conducted investigations and making a diagnosis. It is then, the decision is made whether the patient needs an operation or not. If one needs an operation, will it be done emergently, urgently or as an elective procedure.In effect, he analyses every bit of the patient including the social background and tries to manage the patient as a whole.He is the captain of the team. He is also in contact with the primary care as the long term management of the patient is in partnership with them. I would leave it to you to judge, who would be best suited for the role of the wise men. Competing interests: None declared |
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