Understanding The Medical Services In The City

Rohit had recently migrated to Bombay with his wife and five year old child from a village on the outskirts of Nadiad town. He had an ITI diploma and had found a job in an engineering workshop in Kandivali. Through his sister’s husband who lived with their family in the Approach Road Chawls in Mahalaxmi, Rohit had managed to get a hut on rent in the same locality.

Within their seven months stay in Bombay the child had fallen sick with cold and fever several times and money was being regularly spent on taking him to the doctor. Between paying the rent, commuting to work and paying for the doctor, finding money for food was becoming a problem and when Raksha Bandhan came along Rohit had no savings to buy a present for his sister. He was depressed. He had already borrowed Rs. 100/- from Hasmukh another person from Nadiad who lived close by, and when Roopa his wife interrupted his thoughts by mentioning that the baby had again developed a high fever Rohit exploded, "What kind of city have we come to ! I work like a bullock and yet there is never any money left for anything. Were we not coming down with the odd illness in Nadiad ? There was money enough for food and we were never in debt."

"Nadiad was better than this, " agreed Roopa. "We lived close to the Primary Health Centre and the compounder was our relation. He brought us free medicines and the doctor too was so nice. Here we have to pay for everything and doctor does not care. " His shoulders drooping, Rohit left to see if he could borrow another Rs. 25/- from Hasmukh.

He ran into Rathode who lived two houses away. Rathode worked as a typist with a lawyer and lived with aged mother and younger sister, Anupama, who had passed Std. X and was also learning to type.

"Why do you look so depressed ?" he asked. " I need money to take the child to the doctor. Have you seen Hasmukh ? He’s my bank !" Rohit tried to joke feebly. "Who is your doctor ?" asked Hathode. "In any case, why do you go to a private doctor. WE always use the municipal hospital. My mother is often sick and my sister takes her to Nair Hospital. Why don’t you go there too ?"

"My wife feels very difficult about going to a hospital all by herself and I am free only in the evenings," replied Rohit.

"But it’s worth making a little effort for something that’s cheaper. I’ll tell Anupama to take your wife with her. In fact they are going this afternoon." With this assurance Rohit returned home. Anupama did all the paper work for Roopa at the hospital and Roopa returned home pleased that she had hardly spent anything. She only had to buy a bottle of crocin syrup. The next time the baby was sick Roopa went to Anupama.

"Will you come with me today ?" she asked brightly. "Sorry, Roopa, I am practicising for my typing exam. Why don’t you go by yourself. You know the way by now, " replied Anupama.

That evening Roopa suggested that Rohit take the next morning off from work to go with her to Nair Hospital . "I’ll lose my day’s pay." protested Rohit. "Why can’t you be on your own. "

When Roopa went to the Hospital with the baby the next morning she couldn’t remember what to do. There seemed to be so many counters and when she was asked for her case paper she realised that it was the little piece of paper from last time which she had thrown away. When it was finally her turn, she found a different doctor from the last time.

"What is the matter with the child ?" asked the doctor.

"But where is the other doctor who was here the last time ? She knew. You see ... " " Listen, forget about who you consulted last time. You had better hurry up and tell me what has happened to the child. " The doctor examined the child. " There is no need for medicines. It is an allergic cough which will go off on its own. Don’t give him anything cold. " And the next patient was called in.

Roopa was upset. What rude behaviour ! Not even a proper exclamation ! And no medicines on the top of it all ! " You can make up your mind once and for all. Either you come with me to this free hospital tomorrow and talk to the doctor as he is not interested in listening to me, or I go back to the private doctor, " she told Rohit that evening.

Rohit had got his salary that day. He weakened a little. Perhaps they could go to the private doctor after all. But he recalled what Hathode had said ... " you cannot be spending your meagre earnings in visits to private doctors " ; and said to his wife, " I’ll come with you Roopa tomorrow. Could be you will manage on your own after that ."

This time Roopa remembered to carry the previous day’s case paper and to her delight saw the nice doctor of the first visit.

"You remember me, doctor ? I came here again yesterday and found another doctor ... "

The doctor looked at her blankly ; there was no sign of recognition. Finishing her examination of the child, she quickly made an entry on the case paper, repeated what the other doctor had said and called for the next patient. Roopa felt hut. But it did not seem so bad today ; at least Rohit was with her and they didn’t have to go to so many counters since they had remembered to bring their earlier case paper. And Rohit seemed to believe the doctor that the child would be all right without any medicine in a matter of days.

That evening Rohit visited Hatode. " How did Roopa manage that day ?" asked Anupama, smiling. "You see, Roopa is used to Nadiad where she knew the people around her well --- the doctor, the compounder ---- so she gets upset in an impersonal environment. And when people are rude, she does not know how to react, " said Rohit apologetically. " The private doctor whom we have been going to here atleast recognises us. In that hospital it was so crowded and everybody was being hurried along so much . One didn’t know what was happening. Nobody seemed to care. "

Anupama listened to him thoughtfully. "Rohitbhai, it is true that the public services should be much better than what they are .. more doctors and other staff so that they can attend to all the people who come for treatment efficiently and more politely ; better facilities like more cheerful waiting rooms where we have to wait in long queues ; better organisation so that case papers can be properly prepared and patients can understand things better. People who can’t afford to go to expensive private doctors and for whom the government and municipality run these services, must get a better deal. But if you faced rudeness the other day it wasn’t directed at your specially. It is the general atmosphere of the place. But there are certain things we can do to get more out of these public health services. The first is the case paper. It is very important to preserve this carefully for each member of the family, and to carry it with you each time you visit the hospital. It is like a record of what illness you have had and what medicines you have swallowed, like your ration card which says on what days you took your wheat or kerosene quota. If you always remember to take your case paper it will not matter who the doctor is as they will know from the paper about your health history. The second very important thing is that we must begin to try and understand out bodies better and our ailments better and when we don’t understand we must not be afraid to ask the doctor for information howsoever busy the might look. It is our right. The doctor in the municipal hospital is not doing us a favour. The government or municipality pays for all these services because it is the duty of Government to protect the health of its citizens, especially those who are poor. You pay money to the private doctor.

Tell me, do you ask him questions and does he explain what is wrong with your health and what are the medicines he is giving you ?"

"You’ are right. He doesn’t say much, either. We just swallow his medicines on faith. And we have to wait in his crowded dispensary too, even if it is not as bad as the municipal hospital. " replied Rohit seriously.

Hathode looked at his sister, surprised. "Where did you pick up all this understanding ? I thought my little sister was barely out of school and you are almost talking like a teacher !"

Anupama blushed and gave a delighted laugh. " There is a voluntary organisation which works in the locality where I go to take my typing lessons," she said. "Twice a week they run a balwadi, teach some sewing to the mothers and explain things about children’s health and what one can do on one’s own. Since I finish my lessons a little early I ‘have been down to the balwadi a few times. I help with the balwadi, but also find that I am learning a lot that’s new to me. They have been saying how important it is for women to know more about health, to take initiative without being dependent on their men folk. They have talking about projects where women can become members of banks which give money for building huts in the woman’s own name. And so many other things..."

"It’s going to be difficult for me to find an equally clever husband for you!" Hathode joked. "You’ll get to know too much if you keep going to this balwadi; it’ll make us men look like fools!"

"It will be a lucky man who gets a wife like her. And lucky children who can get a mother who is so modern.... Why don’t you take Roopa with you to the balwadi," suggested Rohit.

"Certainly, if she’d like to come along. In fact there is going to be someone giving four lectures on health at the balwadi for the next four Wednesdays. We could leave the child with my mother for those days," said Anupama enthusiastically.

Roopa these days seemed to be talking all the time about all that she had been heard at the balwadi. Bombay didn’t seem such a strange place after all. Nor were sickness, doctors and medicines such frightening things. One needed to know how to understand and cope with them--- that was what was important. She met other women at the balwadi and they talked among themselves about other things. She found herself talking to her neighbours and urging them to come along too. Rohit was pleased to see the transformation in his wife. The next Wednesday she announced to Rohit, "Today we are going to learn about medicines."

"Your compounder relative will then have to give up his job to you, if we go back to Nadiad," laughed Rohit.