When Jayashree* (32), a post-graduate in mathematics and successful professional in the e-publishing business in Chennai was struck down by a mysterious illness around her 28th birthday she not only succumbed to numerous debilitating symptoms but also faced the prospect of financial ruin.
The affliction began as a persistent discolouration on her fingers upon contact with cold water, but quickly escalated, turning gangrenous and black at the ends of her digits. Within a few years her condition had worsened, drastically transforming her from a vivacious young woman into a pale shadow, hollowed out by disease. She developed dysfunction of the oesophagus and lungs, making it hard to swallow food and breathe.
By this time she had spent more than Rs. 3 lakhs, bringing her family close to financial collapse. As she grew desperate for a solution, only one option remained – to visit the Rajiv Gandhi Government General Hospital (GH) in Chennai.
When she arrived at the massive hospital complex near the picturesque Fort Saint George area it was, as it has always been, teeming with patients from all parts of Tamil Nadu and farther afield.
Yet one physician there, Dr. Meena, was quick to recognise her symptoms and high-tech genetic and auto-antibodies testing confirmed her suspicions – Jayashree was at an advanced stage of a chronic autoimmune condition called scleroderma.
Resting peacefully in the sixth-floor rheumatology ward, Jayashree spoke softly as a powerful biologic, an immune-suppressant called Endoxan, trickled down an IV tube into her veins. It was being provided to her free of cost. She had no privacy from her neighbours, other women patients receiving similar treatments in beds adjacent to hers, but the ward was clean and she was being closely supervised.
Her story mirrored those of so many others there, of lives ravaged by disease and consequent economic catastrophe, including little Nivedita (7) crippled by arthritic pains, Lakshmi (25), suffering from frequent falls owing to a condition called idiopathic inflammatory myopathy, and Gopal (26), whose ankylosing spondylitis condition had fused his spinal column and immobilised him.
GH treats almost entirely free of cost approximately 12,000 outpatients per day. It has at least 3,000 beds. While its waiting area and corridors are clogged with families of patients sleeping, eating and living their uncomfortable lives, a new block is being built to accommodate even more of those who cannot pay for private medical care.
Dr. Meena compares the intake of vast numbers of patients to accepting asylum seekers: GH welcomes patients of all backgrounds and all degrees of criticality, she says, and only genuine medical need is a factor in deploying state-the-art testing equipment such as the Fully Automated Immunoassay Analyser.
Notwithstanding the dedication of GH staff and the service provided by the network of government hospitals across the state to those near the bottom of India’s steep economic pyramid, many from this stratum fall through the security net and land in the jaws of the private healthcare system.
According to medical journal The Lancet, outpatient care by private general practitioners and pharmacists as a proportion of all doctor visits in 2014 was 71.4 per cent in rural areas and 78.8 per cent in urban areas. Meanwhile private inpatient care rose sharply from 40 per cent in rural areas and 39.6 per cent in urban areas in 1986–87 to 58.1 per cent in rural areas and 68.0 per cent in urban areas in 2014.
In this light it is significant that the well-worn argument about the constrained capacity of the overburdened government hospital is being challenged in some ways, for example in the case of Chennai’s Tamil Nadu Government Multi Super Speciality Hospital.
Neuro Vascular Cath Lab at Chennai’s TN Multi Super Specialty Hospital — being used to non-surgically treat ruptured blood vessels within the skull. | Photo: Narayan Lakshman
The MSSH, which began operating in 2014, is a 400-bed, referrals-only institution, and it provides sophisticated care through 11 speciality departments, entirely free of cost. Among its assets the crown jewel would have to be its Neuro-Vascular Cath Lab, a state-of-the-art machine that doctors use to non-surgically treat arterial occlusions, tumours and similar conditions in hard-to-reach areas such as deep within the skull.
Sanjiv (16), a patient there, smiles excitedly as he explains how the Cath Lab doctors led by interventional radiologist Dr.Shivam saved his life, repairing a blood vessel behind his eye that was ruptured by a fragment of his skull bone following a facial injury. The procedure took a little over two hours, there was no charge to Sanjiv’s parents and the time from admission to discharge was less than a week.
The experience of many patients such as Sanjiv leave little doubt that Tamil Nadu’s public healthcare system is a lifeline to vast numbers among the poorer sections of its population.