As I speak to my father in India from hundreds of miles away, I can’t help but feel the helplessness in his voice. He has been a practicing cardiologist for over 30 years. One amongst the doctors in a country which has a ratio of 0.8 physicians per 1000 people which falls drastically short of the standard value. Like every other physician he is overwhelmed by the ongoing covid crisis, despite being in a private hospital in a comparatively well-resourced state like Kerala. Imagine the plight of millions of other healthcare workers around the nation, putting themselves at risk while also trying to prevent the number of deaths from passing grim milestones.
By now it is quite evident to what extent the government has neglected the healthcare system of the country. The fact that India’s total healthcare spending (out-of-pocket and public), is at 3.6% of GDP, as per OECD, is way lower than that of other countries has been repeated multiple times in the media and economic articles. However, it took a pandemic for us to realize how grave the situation of our public health system really is. As of April 29th, over 200,000 cumulative deaths, an uncontrollable surge of cases and reports of oxygen shortage and lack of critical beds across the country are nothing but the repercussions of the dereliction of duty from our leaders. COVID-19 has today put an ultra-bright spotlight on how the current ruling party chose to prioritize religious sectarianism over strengthening the healthcare infrastructure of our country. Although, it should not be forgotten that India’s healthcare system has been neglected historically irrespective of which political group has governed the country.
The brunt of this negligence has most often been felt by our healthcare workforce.
It has been reported that a total of 174 doctors, 116 nurses and 199 healthcare workers had died due to COVID-19 in the country by February 2021 and hundreds still remain unreported. These whopping numbers are alarming because the curve continues to rise and within a few days the case load on India’s already overburdened health system can further debilitate our healthcare workers. Insurance schemes were promised last year by the government to protect the healthcare workforce impacted by the pandemic. The centre that earlier decided not to extend the scheme had to reconsider its decision after the appeal from the Indian Medical Association.
Above and beyond the financial incentives, pre and post COVID, what needs to be focussed on is how undervalued our healthcare workers in India are actually. Several reports from the past show how doctors and nurses have been victims to workplace violence by dissatisfied patients and their bystanders and the manhandling continues to occur even during the COVID crisis. There is a general lack of trust and respect towards these healthcare professionals and often the expectations towards them are unrealistic. The mental and physical abuse is omnipresent across all hierarchies, genders, classes and it does not seem to matter if they are government or private employees.
The cliched rebuttal to the mistreatment that healthcare professionals face is that ‘this is part of their job’ or ‘they chose this path for themselves’. We put our leaders who hold political rallies and promote religious festivals in the midst of pandemic on a pedestal. We cheer for these men in power, defend them on twitter and social media platforms. We trust them to run our country and blame them when they fail. In between the glorification and condemnation our healthcare heroes are forgotten.
We cannot hold a doctor or nurse to the level of a government employee. While they are both equally accountable roles, they serve different responsibilities. Nonetheless, what we can do is demand for healthcare professionals to take up roles of leadership in India. Typically, doctors or nurses who work to heal the wounded and alleviate pain are viewed as noble professionals. It is high time we stop seeing these professionals as noble kings and saints and train them to take charge as leaders and effective communicators.
The COVID-19 pandemic has taught us now more than ever that public health is a multisectoral effort. Around the world, medical professionals have been challenged by this novel virus and healthcare systems have been grossly underprepared to manage the deadly disease. Although our healthcare workers in India are amongst the best trained in the world, they are seldom involved in decision making processes around accessibility and cost of care. Compared to many other professions our healthcare workers are neither taught management and communication skills nor are they rewarded for good leadership. The root of this can probably be traced back to our medical education system failing to expose medical graduates to managerial sciences, health policy and broadly beyond clinical medicine.
America’s chief medical advisor, Dr. Antony Fauci, referring to the horrible situation in India, said recently that “many countries were already aware of what needed to be done to fight Covid, but that it [the US] was failing” (i.e. by being too focused on itself). In addition to his academic credentials, he has exhibited desirable leadership traits by repeatedly speaking the truth and, in doing so, contradicting statements made by the erstwhile president of the United States, even while standing next to him on a podium. He acted with authority and communicated powerfully during a very tumultuous time for the United States. I have been watching the often confusing and unclear press briefings by our prime minister and have often wondered when India will have its own version of a Fauci. Millions of doctors, nurses, and allied health professionals have witnessed countless patients gasping for air and fighting for hospitals beds. They have been left to fend for themselves in the battle against the coronavirus. It is high time that our elected leaders prioritize the welfare of medical professionals and ensure that they receive the training required to lead effectively during future public health crises.