Empathy begins at home

Another original post on Facebook, September 5th:
 
Teacher's Day has got me reminiscing...

My mother passed away 5 years ago this month. While she formally trained as a teacher (for kindergarten and then middle school Maths and Science) and worked for some time, she did not enjoy the test-driven, regimented curriculum of most traditional schools. For her, sharing the joy of learning was most important. She enjoyed babysitting and tutoring and, with patience, was able to help 'difficult' children improve their performance and enjoy learning. When I was unable to grasp some concepts, she would ask questions and lead me to clarity even though she was not familiar with the subject/topic herself.

And she taught me empathy. I don't remember specific incidents from my childhood, but I can clearly recall one from about 7 years ago. By then, she was already ill and increasingly turning inward. I was telling her about the deepening communal and religious divides in India and how the 'other' is being dehumanized. Generally, when I have talked to my relatives about such issues, they either say 'oh, how great that you work on this' (again making me the 'other') or ask me why I'm wasting my time and not working in IT.

My mother, instead, related to me her conversation with a maid who worked for us in the 80s: When this young woman came to meet my mother the first time, she set her terms and then said 'I should let you know, I am a Muslim. Please decide if you want me to work for you'. My mother said that it was fine and Saira went on to work for us for many years. Recounting this incident, my mother said, "I felt so very bad - why was it even necessary for her to have to say this, to anticipate rejection?"

My mother wasn't a scholar or a radical. She wasn't as brave as her dreams and aspirations needed her to be, and so was dissatisfied with her life. But she gave the best of herself to guide others, as any good teacher does. And today, in the midst of so much indifference to human suffering, I wish more people could have her basic decency...

On rational thought in India...

I have been writing more than usual in the past few months - problem is, it's mostly on Facebook! In the interests of better archiving, I'm posting a couple of original writings from there. The following was posted on August 31st, soon after I heard of the shooting of Prof. M. M. Kalburgi, a rationalist and scholar:

My mother's brother is visiting today - my astrologer cum Vaasthu-consultant uncle who has magical abilities. He can influence people to tear down newly built houses/offices because the way they were built has caused marital strife, business losses, deaths... He advises people to perform all kinds of rituals to ward off their impending 'bad times'. He even re-writes history - yesterday he told me that my late mother became a veena virtuoso in a few months (and after that, never touched a veena again because she didn't have one after marriage - WTF?). And he claims that he never told me the world was ending in 1999 - the gravitas with which he laid out the destruction from tidal waves, earthquakes etc. had scared the sh** out of the childhood me for years. Now he says that half of India's population will die in 2037 and a messiah will come forth to lead them to a better future...

Oh wait, he does admit his mistakes occasionally. We had had a raging fight 12 years ago because I said that chillies came to India in the 15th century and he claimed that they were mentioned in the Vedas. A few months ago, he came back and told me I was right - wow!

I do care for my uncle, but I think it outrageous that he earns lakhs of rupees for a few days' work, is revered by many and considered a great man. And what happens to people who point out the flaws in such beliefs, who try to get our blind-ritual following, mob-mentality type people to think on their own for a change? Bang Bang! The truth hurts, so let's destroy the truth tellers..

Health care in India - making the poor pay

A few days ago, I visited a government hospital in Bangalore. The staff we talked to were unusually open and frank - possibly because some are new hires! I will give no specifics about this facility to protect them, but also because the problems they face are not unique.

The building has been recently renovated using crores of rupees, but there is barely any furniture, even for the staff. The operation theatre is not functional because of poor planning and construction, so while specialists are on staff, even minor operations cannot be conducted. For these expenses, the doctors were waiting for the release of Arogya Raksha Samiti (ARS) funds - these are untied funds that are to be used for repairs, emergency medicine purchases etc. We said that these were construction-related issues, so why should ARS funds be used for them? They said that they had asked the MLA and corporator, but hadn't received any support as yet, so this was their only recourse.

The hospital has a functional lab and lab technician, but only pregnancy and HIV tests are being conducted. For other tests such as thyroid and haemoglobin tests, reagents are required which have to be purchased. The hospital started collecting user fees recently and these will be used subsequently for such purchases. The one fund that they do have in abundance is the one for maternity benefits, which amount to Rs. 2000 per BPL (Below Poverty Line) woman, paid out in 3 instalments. The on-duty doctor mentioned that she had been generous in handing out these cheques earlier, disregarding some documentation requirements if the woman seemed genuinely poor. Also, she was allowing the woman's relatives to collect the final cheque (which had to be collected after delivery within a month). After all, the cheque is in the woman's name. But an audit of the hospital had generated multiple objections. The auditor had said that the documentation was incomplete and the signatures in the register did not match! The doctor said she would have to be more strict in the future.


The latest round (71st) of NSS data collected in 2014 shows that rural families spent, on an average ₹1587 for childbirth in a government hospital and urban families ₹2117. Major expenses include ultrasound scans (3 are required during pregnancy) and diagnostic tests, which are done in private labs. Neo-liberal economists and policy-makers might argue that these expenses are reimbursed for BPL families through maternity benefits, but as shown above the requirements get tougher and tougher for beneficiaries. Further, are only BPL card holders poor or vulnerable? Wouldn't it be cheaper and simpler to provide all these diagnostics under one roof? And user fees, among the most regressive forms of taxation (this actually discourages people from seeking essential health care, further impoverishing them) are being used to buy essential products!

I also realized how staff, especially the dedicated (of fresh!) ones, interpret the expenses of the hospital and its sources of revenue. They have little to no control over the funding from above. All they have are the user fees. One example - the fee for a rabies injection is ₹ 100 - apparently half goes to the department and half stays with them. Along with patients, front-line staff are also made responsible for funding health care! 

How do we talk about Universal Health Coverage?

Where health provisioning is concerned, Universal Health Coverage (UHC) has been the defining term for the past few years. WHO has taken it up with enthusiasm and the Indian government likes the word a lot too. In fact, recently Karnataka announced that it had achieved UHC!

I was at a meeting organized by WHO earlier this month, where a film was screened that talked about what UHC 'was' and 'was not'. But there were few specifics and all the visuals focused on antenatal and postnatal care. It is true that we, especially in India, have not yet achieved these basic targets. An example - the Community Health Centre (CHC) in Pisawan, where Sangtin Kisan Mazdoor Sangathan (SKMS) is active, does not have access to running water and its sole hand pump stopped functioning 2 years ago. Recently, a woman in labour left the CHC to find a place to urinate (the toilets there are always locked). She ended up delivering there.

But can UHC remain limited to ante- and post-natal care, deliveries, immunizations and some communicable diseases? When people have to go elsewhere for their other health needs, they will not necessarily return to government services for these. Barely half a kilometre from the Pisawan CHC is a private practitioner that even the poor in these parts rely on. He most likely does not have an MBBS degree (those who do display the information proudly!). A few years ago, he sat in a small shop-front clinic. Now he has an immaculate waiting room, a ward of sorts with a few beds and an examination room. Once as we waited to speak to him, he examined patients with all kinds of symptoms with the attention and 'human touch' that they do not get in the CHC. He wrote up long lists of medicines for most of them. This is the health care most Indians rely on.

To move from what we have to a system that promises true UHC (many health activists instead use the term Universal Access to Health Care), we have to better explain what we envision. I hope to work more on this in the coming months...