These two topics mentioned in the title were two very big topics that we were constantly talking about during our clinical rotations and in our free time we experienced a very different culture from our own. As we learned through the CFHI program, India’s work culture is very lax compared to that of the United States. This helps create underserved communities, especially in the rural areas of India, because doctors do not want to make the effort to get to these areas that most need care.
During a visit to the rural site, Dr. Dabak explained to us that even though four doctors may be posted to one rural hospital or clinic, only one may be available at a time even when all four are supposed to be there. The work culture in India, as we have seen, is very laid back and sometimes even lazy, especially when it comes to serving a rural community. Often time’s doctors will show up late, not stay very long, and not do a thorough job of examining patients.
Specialty care is also a problem in areas outside of the city and it is often times impossible to get the care needed without community many kilometers. This is one of India’s biggest problems. Even though cities are large and over-populated, 70% of India’s people still live in the rural areas without access to proper nutrition, hygiene, or healthcare (Dr. Dabak).
People simply don’t have the means to travel the necessary distance to receive the care they need, especially pregnant women who have responsibilities and most of the time other children to attend to. These facts add greatly to the maternal and infant mortality as well as child mortality in most developing countries, especially India.
There are two ways that India is combating these problems at the grassroots level. The first is the government is requiring a two year rural service commitment of new MD’s before they can receive their diploma and ultimately their license to fully practice. This forces there to be well-educated, competent doctors staffed at the rural clinical. The other way that the government of India has been working to bring healthcare to every Indian is by creating a hierarchical system in which care is provided.
The first step on this ladder of healthcare is the primary health center, placed for every 6,000 or so people. Then there are government clinics that provide care for a smaller number of people. And in each district there must be a district or rural hospital that is capable of taking traumas, doing minor surgeries, and attending births. These hospitals must have full time staffs including one doctor, nurses, and paramedical workers that are trained to work in the field.
Along with these health centers there are health workers who are responsible for seeing that the DOTS therapy for Tb and leprosy are carried out properly, and that every birth in their given area is attended. They are solely field workers and are trained to go door to door to provide the necessary health care. It should also be noted that all of these services are provided free of charge to the patient, necessary drugs and injections included.
The steps that the India government is taking are helping to achieve a better picture of global health in India. I feel that the system that India has could be a model system for any developing country given enough funding and manpower to make it happen!