Student Perspective: Free Healthcare in Andhra Pradesh

When I visited my family after the STEM Reverse Innovation program ended, I had the opportunity to shadow my cousin Kishan who was doing his Residency in the surgery department at a government hospital in Vijayawada, the capital city of Andhra Pradesh. My family joked that I would not continue to want to be a doctor after seeing the conditions of the government hospital, but I braced myself and powered through to explore what the government of India is doing for the healthcare of the poor.

Kishan had “injection rounds” that evening, basically checking on patients and providing painkillers for pain management of post-operation patients before the attending physician’s rounds. People often say that visiting India overwhelms your senses, an understatement when visiting the government hospital. Words cannot describe the unimaginable combined smell of wounds festering in the humid heat, of body odor of patients and families who have not showered in days, of bathrooms not cleaned for who knows how long, and of expired antiseptics. Families wailed at the bedside of hundreds of patients while nurses clamored around to appease families and communicate with other nurses about patients. Visually, all of the equipment was dilapidated, from the beds that looked like they belong in a World War II movie set to yellow-brown respirator tubes. The hospital provides completely free medical services to anybody who shows up at the door, typically geared toward those at the poverty line and below. As a consequence, government hospitals are overflowing with patients but lacking adequate supplies to provide them full medical attention.

As Kishan and the other residents started filling syringes for painkiller injections, it quickly became apparent that any sterility guidelines were thrown out the window. Filled syringes were tossed on the table that was clearly nowhere near clean, much less sterile. The tops of glass medicine vials were hacked off and onto the floor for janitors to (probably not) sweep up later. Exam gloves were not even in sight. When I voiced my concerns, the residents replied that the sheer volume of patients that they go through does not allow the time or resources to be sterile. One resident shrugged off my appalled look, saying that during a surgery earlier that day, HIV-positive blood was dancing on her bare hands. Bare hands. During a surgery. They went on to tell me that I came on a good day, at the beginning of the month when they still had supplies. The hospital receives about a week’s worth of supplies and drugs that have to last a month. The shortages get so bad that syringes and needles will be kept with the patient to reuse them for a couple of rounds of painkillers. Some days, the residents are forced to inject only saline and pretend that it’s pain medicine (which often still alleviates pain but that’s not the point).

Despite such challenges, the doctors were clearly brilliant and practiced excellent medicine. We saw patients recovering from miraculous surgeries, ranging from limbs that could have been amputated to brain tumors cleared right up. Naturally, such working conditions and stress from overwork put these doctors and nurses in terrible moods, but they treated each patient with the utmost respect and embodied the humanistic side of medicine that is increasingly absent today. If the attending physicians saw or heard about any nurses or residents putting in IV ports too roughly or snarking at patients or families (even something as minor as using informal rather than formal pronouns to address), they got an earful in front of everybody. Likewise, most patients treated the doctors with respect and adoration. As soon as a white coat strolled into the room, hands go up in Namaste to greet the doctors who don’t have to work here, don’t have to put up with frequent patient and family abuse, and don’t have to endure these working conditions to help people who are way below them in caste (a system still strong in the minds of many Indians). The ability to give hope to people who have nothing is why my cousin purposefully picked the government hospital over private hospitals for his residency, and that wholehearted Namaste is his reward.

Student Perspective: The Endgame

Heading out this morning, our group was prepared for a visit to the non-consumer segment of the “Mainstream Poor.”  We knew that our host family would have a little more than those we met in the “Urban Slums” the day before, but it quickly became evident as we ducked into a relatively clean alley in a bustling center of Chennai that this setting was much different.  Our host mother welcomed us in to a relatively spacious room (the size of a slum dweller’s entire home) with a ceiling fan on full blast, a large TV, seating room for the ~7 visitors, and religious decorations.  As classic homemade Indian coffee was passed out to us, she explained that she lived in the two-story complex with her husband and their two children, her parents-in-law, and her brother-in-law and his wife and child.

Though not as prevalent as in the past, joint families are not uncommon in India, particularly in southern States such as Tamilnadu.  Our host related to us in near-perfect English the daily lives of the families and the advantages of living with a whole another family.  Both sets of parents work during the day, so the grandparents take care of both sets of children, preparing all meals of the day and making sure they get to school when the family driver (chauffeur) could not take them.  They have a maid that helps with cooking and cleaning the home, and the home has air-conditioned rooms with Western bathrooms and a computer room/game room with Wi-Fi upstairs for the children.  The two brothers run an electrical installation business, and the host mother worked for the patent office.  The children go to one of the best schools in Chennai.  The children’s English abilities and frequent computer-based assignments were indicative of their top-notch primary education.  Even without health insurance, healthcare was easily accessible through the many hospitals and clinics in the surrounding area.  The joint family arrangement provides the children with stable companions growing up and allows the chores and costs of the home to be shared among two working families and one retirement-benefits-receiving family.   Every grown member of the family had cellphones, including a couple of smartphones, and the home has a generator to deal with power outages.  About once or twice a month, the families go to the movies or a nice restaurant for entertainment, and last year, they even took a vacation to the beautiful state of Kerala.

Just from this simplified summary of this household’s life, one can see that this is not a “poor” family and that their lifestyle and amenities classify them into the middle class.  While this family may not have been exactly indicative of the “Mainstream Poor” that our program was trying to express to us, to me the family represented the endgame of the work that our group and thousands of people across the world are trying to accomplish.  Often when people are working to solve poverty, they have idealistic notions of raising the poor’s lives to those we are accustomed to in the Western middle class and above.  However, poverty solutions just have to get the poor this far, to the stage of this lower middle class joint family.  Even with all of the amenities, their home was modest and probably not the most comfortable for that many people.  However, it was very clean, and the family was on track for a comfortable, sustainable life with gradual improvements.  Because the parents were educated, they are able to bring in moderate, steady income to provide everything that their children need to receive a good education and elevate themselves even higher than to what the parents have done. The infrastructure around the home was well-developed, and the support system through the joint family was strong.  To me, this family was proof that solving certain, understood aspects of poverty will actually be successful in raising people out of poverty.  Education, unsteady income, sanitation, support systems, empowerment, and various infrastructure issues are generally accepted keys that we have seen firsthand to attacking poverty in developing nations, and to me this last field visit provided optimism that these issues can be solved and that with a little help, people can reach this self-sustaining level on the way to a better life.