Not so normal… not yet!

“Doctor, please do not think I am bargaining,” the patient said, “I am in a totally different situation today compared to two years ago.” As he said this, I could see he was fighting back tears. Adarsh (name is changed) had everything going for him. He had a dream job. The family was doing well on the whole. Father was a pensioner; but needed additional support as he had significant health issues. Adarsh took pride in the fact that he was able to support his parents in their old age. That is when things took an ominous turn. At the outset, it seemed like a temporary affair. Then the reality hit. Lockdowns and extended lockdowns meant some industries and companies would have to shutter their doors. There would be lay-offs. Adarsh thought the maximum that could happen to him would be that he would have to forego his increment for the year. He was too valuable an employee. But worse things were yet to come. When Adarsh received the proverbial pink slip, he felt he was in a trance. As weeks turned into months and months into a full year, he had to borrow money and also cut back on many things the family thought were essentials. When he was diagnosed to have symptomatic gall stones, epigastric hernia, and a gastric leiomyoma – all at once – he was left speechless. “I am happy this is not cancer; but how do I afford treatment for this?” Though he was assured that treatment in the subsidized general wards would be much cheaper, it was still going to be a burden on the struggling family.

I would like to dwell on the economic realities of the post-Covid era. Adarsh is just one among millions who have faced the ugly face of an economic downturn. What does this have to do with the medical community and the work that we do? Indian medical care is in fact among the cheapest in the world. The best in medical expertise and advanced technology is surely available here. But even this is out of reach for the overwhelming majority.

Though there is the safety net of government schemes like Ayushman Bharat and other plans, 70 percent of India’s healthcare is delivered and administered by the private sector. While the medical community alone should not be burdened with the societal need, we have our share of responsibility. Keeping the costs to reasonable levels, developing viable cross-subsidy models, and at times tapping into the philanthropic good Samaritan spirit of those around us are imperatives. Trimming the extras, while delivering on the essentials, is something the hospital administration and the clinician should be involved in. If we can do this to at least a quarter of our patients, it will be a great service. At the end of the day, we will not be the losers. We can only gain, and be enabled to do more!

Another sobering thought is that it may not be a post-Covid era, after all. We may still face further waves. God willing, the future waves will be much smaller and more manageable. For sure, this pandemic has taught us that we have to pull up our socks. We are on notice in this globalized world, where no country or region is safe till every corner of the world receives the basics of health care and preventive medicine. Immunization is to receive a big push. Much has been done… but much more needs to be done. Eradication of poliomyelitis is a wonderful example of how the nations of the world worked together. Could we do the same in this instance too?

When it comes to Covid-19, the tiny nation of Israel has led the way. As of today, it is the most vaccinated nation in the world. Over 90 percent of those above 60 years of age had already received the third dose by the end of January this year. By the middle of January ’22, over 500,000 had been administered the fourth dose of the vaccine. Since there is not much else that we can do while keeping economy on the move, this is something we must emulate.

As I pen this, I have received the good news that the booster dose is now available to all adults in India. A welcome move! In the ultimate analysis this strategy is probably what is going to be most cost-effective. The macro decisions are for the decision makers to make. Meanwhile, we must do our bit – making a difference wherever we are and wiping one tear at a time. Jai Hind!