The primary need

WHEN THE Public Health Centre, West Mambalam, celebrated its Golden Jubilee recently, gastroentologist Dr. N. Rangabashyam's special address was as brief as it was pointed.

What this country needs is more toilets he bluntly stated. Such measures to prevent disease are what we should be looking at before talking about healthcare in the 21st Century - which was the theme of his address.

Improving public hygiene and providing greater sanitary facilities have been talked about for years. But they are particularly lacking in Tamil Nadu still. When in a city like Madras there should be free toilet facilities near every slum and easily accessible ones at every mile or so from each other, there is not even talk of doing something about this woeful shortage in the city. Even a road like Mount Road, an important, much used thoroughfare, doesn't have a single public toilet facility.

Yet, we talk of the city being the `medical capital of India', we build major healthcare institutions, we spend hundreds of crores of rupees on new landmarks. But toilets, regularly cleaned and maintained to ensure prevention of disease, are no one's priority. No wonder Dr. Rangabashyam's forthright call for action against defecating, urinating and spitting in public went almost unnoticed by even his audience.

All that was said about the Public Health Centre, growing from a thatched hut to a multi-speciality, 120-bed hospital in 50 years, also made me feel that hospitals that charge affordable rates are a primary need for the city.

The Government should perhaps be thinking of joint venture efforts with the public to set up such `mini-general hospitals', one in every two or three zones of the city.

With Government playing the donor role and boards comprising citizen volunteers overseeing professional management, hospitals modelled on the Public Health Centre could take the pressure off the major general hospitals, leaving them to deal with complicated cases. But a health policy, both preventive as well as facility-oriented, particularly in urban areas, is what no one is focussing on in Tamil Nadu.

Greater attention is paid to visibly marking the contributions of people - with names, statues, photographs, etc. - than to the sustained care of the contributions themselves. No wonder, M. C. Subrahmanyam, the publicity-shy Gandhian who, with a group of volunteers, nurtured the Public Health Centre from its birth, stated in his will:

"So when the end comes, you will NOT be honouring my memory:

a) If you close the PHC or any other institute to mourn my passing away. No man shall be denied of medical or other necessities because some obscure person died;

b) If you put up any portrait or any other representation of any physical being anywhere in the PHC complex or in other place;

c) If you name any building or part thereof after me."

MC's injunctions may not have been exactly followed in the spirit, but his hope that the PHC would continue to provide committed service to the weaker sections of the public in West Mambalam is still nurtured by the volunteers whom he inspired.


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