Initiatives: Healthcare and Nutrition

an excerpt from our upcoming website
written by Sriram Ramgopal

Healthcare: Problem Statement
Healthcare - and the lack of easy access to it - prevents people from upward social and economic growth in India. The lack of healthcare stems from two important issues:

The first issue is a lack of access. Healthcare facilities in India are difficult to access. Government hospitals, though technically free, are so burdened by a massive population of patients and a deficiency of qualified medical staff that they simply cannot cope with the load. They have a perpetual shortage of essential medicines and are simply unable to do essential diagnostic and therapeutic procedures. Corruption in such hospitals also plays its role in limiting access to ordinary people. Thus, people are unable to utilize these hospitals in their time of need. "Experts and the general public perceive public hospitals as inefficient, dirty, unhygienic and their staff as rude, negligent and callous," writes Ratna Magotra, for the Indian Journal of Medical Ethics¹. However, while 'free' government hospitals are unusable, impoverished people in India simply cannot afford to go to more expensive private hospitals, where the costs of treatment are exponentially higher than what they might earn in a year - or even in several years. The long-term costs of treating chronic ailments such as diabetes and hypertension put a heavy, often unbearable burden on people with a limited income.

The second issue preventing access to healthcare is a lack of knowledge, awareness, and initiative and an ignorance about the importance of health. Such a statement is not intended to allocate blame to these people. However, they are unaware that treatment is available for many conditions, that it is affordable and easy to obtain. They do not know that many diseases - such as debilitating complications of diabetes - can be prevented by simple and inexpensive means. Perhaps more ominously, we have found in our short work here at Ramavaram that patients are unwilling to receive treatment, even treatment that they perceive as necessary and that our group has been willing to sponsor. This can be attributed to a cynical attitude towards the healthcare system and the importance of good health in their lives.

The economic and social toll that lack of proper healthcare takes in such urban communities cannot be calculated in any straightforward way. Children suffer in school because of undiagnosed refractive problems. Adults suffer from bone aches due to osteoarthritis. Acute trauma such as fractures from road traffic accidents, when improperly treated, prevents adults from being economically productive in the future. Death tolls in children due to untreated diarrheal and respiratory diseases are also distressingly high. The tragedy is that many of these people suffer from conditions that can be treated easily - and often inexpensively.

The Importance of Healthcare in Community Rehabilitation
We have chosen to work on heath care for several reasons. Most of our members, being students and workers in the healthcare field, grasp the vital importance of health in the chain of human suffering and poverty; we share a keen sense of empathy for their pain. Our belief is that ethically, the choice of providing health care when we have the power to do so is a matter that requires little deliberation. We see it as a clear responsibility with few shades of gray to complicate the issue. Helping those who are sick serves additional advantages as well. It allows people to get to work and to school and to become productive - thus breaking a chain in the disease-poverty-disease cycle. Socially, it shows our solidarity with those who need help and creates a strong bond with them based on our concern for their welfare. This leads to trust, and over time, it allows us to work with these people in other arenas as well, such as education and vocational training.

Our philosophy of health care is that of 'self care.' When someone is sick, we believe that the immediate course of action is to help them get better. However, this is not the end-all of health care as it does not provide a long term solution for health problems that are an inevitable part of life. People from impoverished backgrounds lack access to healthcare for a number of reasons. But armed with information and support, they can make the right healthcare choices and play a positive, active role in their health.

Our Approach to Health Care
Our approach to health care has a number of facets. As the axiom says, "An ounce of prevention is better than a pound of cure," and this certainly applies to underprivileged communities. Health education is an important part of this process. Teaching children and adults alike the importance of basic hygiene and sanitation is critical to combating common infectious diseases. Preventing children from using drugs forestalls long term, chronic health problems ranging from alcoholism to lung cancer. Informing women about contraception and its importance decreases complications associated with excessive and frequent childbirths. Thus, health education is the cornerstone to our approach in underdeveloped communities. It is the cheapest and the most effective way to avert disease and debility.

Prevention, though better than a cure, by no means replaces it. It is also important to develop ways to treat patients who are in need of curative therapy. We plan on increasing access to health care by two means - bringing health care to those afflicted with minor conditions, and for more serious conditions, taking them to centers for definitive treatment. Bringing health care to the community involves running health camps and bringing qualified medical professionals to help the residents deal with their medical complaints. By eliminating the cost of treatment and bringing doctors to their own neighborhoods, we can surpass many of the barriers that they face in getting treatment. By individually assisting the patients, we help them overcome their fear of what seems to them as a complicated and menacing system and get them the treatment they deserve as human beings.

To finish the rest of this article, check back on our upcoming website, releasing June 2009.

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1. Magotra, Ratna. "Revitalising public health care." Indian Journal of Medical Ethics. 1995. Forum for Medical Ethics Society. 14 May 2009 <http://www.ijme.in/034ed068.html>.