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HEALTH-INDIA: Hunger Haunts Hospitals

Ranjit Devraj

NEW DELHI, Jan 2 2010 (IPS) - As a nurse, Amita Dhaka sees much suffering, but what she finds hard to handle is inadequate nutrition and even hunger among poor in-patients.

At the busy, charitable hospital run by the Rural Medicare Society (RMS) at Mehrauli, on the outskirts of the national capital, where Dhaka is employed, there are provisions for poorer patients. But this is not the case with most state-run or private medical facilities, where patients are left to their own devices when it comes to procuring prescribed medicines or getting their meals.

Unlike in most other countries, in-patients in India must bring along attendants, usually family members, to buy medicines, fetch meals, do the paperwork and help the nurses. These attendants can be seen sitting beside hospital beds or crowding around the corridors.

“The problem is that attendants also require meals, and we see that very often they end up being an additional burden on the pockets of patients admitted in hospital,” said Dhaka.

According to Dr. Aarti Vasisht, one of 28 doctors and surgeons working at the RMS hospital, providing patients with timely, balanced and nutritious meals is important because it has a direct bearing on recovery.

The chest specialist added that many of her patients are being treated for tuberculosis and are on heavy medications. “These are people who need to be on special diets and must be provided timely, nutritious meals,” she said.

Vasisht has been able to arrange free meals for her patients at the RMS hospital from the charitable Santhigiri Ashram, which has a mission of providing free or subsidised food and medical care for the needy.

“We hope to expand these services and reach other hospitals in the national capital, but this is not easy in a time of recession when the prices of food items have gone through the roof,” said Swami Pranavsuddhan, director of the Santhigiri Ashram. “The good thing though is that this is a cause that people seem interested in supporting, and New Delhi is a city of wealthy people who believe that feeding the poor and needy can add positively to their karma.”

Santhigiri sees to it that its food packets contain simple but balanced meals that are suitable for the convalescing patients as well as their attendants.

“These free meals go a long way for patients who may have to spend 300 rupees (6.4 US dollars) or more for each day of hospitalisation, which is an enormous burden for people living below the poverty line, earning less than two dollars a day,’’ Vasisht said.

“In India’s healthcare delivery system it is hard enough to get affordable medicines to most patients, and so the question of ensuring that they eat well is glossed over although everybody is aware of the problem,’’ she said.

The latest review of the National Rural Health Mission (NRHM), released last week, speaks of continuing difficulties in providing free drugs to patients and “the imperative of prescribing medicines from outside,” when the government is committed to raising public spending on health from 0.9 percent of gross domestic product to two to three percent of GDP.

Many public hospitals, says NRHM – which has the stated goal of improving the availability of and access to quality healthcare for people, especially those residing in rural areas, the poor, women and children – now run commercial pharmacy shops within their premises.

What that means is that patients who do not have the cash to buy medicines with may have to do without them. The same goes for the hospital canteens from where patients are expected to buy food for themselves and their attendants.

In sharp contrast to the services at the RMS centre are the swish hospitals dotting the capital that cater to the health needs of the well-to-do and to a burgeoning medical tourism industry that attracts 450,000 foreign patients each year.

Hospitals such as the ‘Indraprastha Apollo,’ which ranks among the world’s biggest private health facilities, do not allow attendants and provide patients with meals prepared under the careful supervision of dieticians.

Reflecting the paradox, Britain’s Oxford University commented in a study released in March last year that “quality healthcare remains inaccessible throughout the country [India] despite the presence of a highly skilled and qualified medical workforce.”

According to the study one million Indians die every year as a result of inadequate healthcare and that 700 million of India’s 1.1 billion people have no access to specialist care simply because 80 percent of specialists live in urban areas.

The NRHM, which runs from 2005 to 2012, was set up after the government recognised that curative services favour the rich and that for every dollar spent on the poorest 20 percent of the population, three dollars are spent on the richest quintile.

Only 10 percent of Indians have some form of health insurance, mostly inadequate, and hospitalised Indians spend, on average, 58 percent of their total annual expenditure on medical care.

The NRHM also acknowledges that over 40 percent of hospitalised Indians borrow heavily or sell assets to cover medical expenses and that over 25 percent of hospitalised Indians fall below the poverty line because of hospital expenses.