Rana Dasgupta - Capital - The Eruption of Delhi

“I learned the law then and I will learn medicine now. I helped at least twenty people after my court case and I will help many more when I find out what happened to my husband. I am hungry for knowledge. I worship knowledge. For me anyone is a superior person who can answer the questions that are troubling me.

“We didn’t have health insurance. We paid everything ourselves. The hospitals wanted to put him on a ventilator for a month so they could charge us 30 lakhs [$60,000]. They tried to put him on dialysis because they had a new dialysis machine. But there was nothing wrong with his kidneys.

“Terrible things went on. I met a woman who had come in for a heart attack. Her arms were blue from the wrist to the shoulder from tests. How many tests do you need to do to a woman with a heart attack? But you can’t ask any of those questions. Doctors have complete legal immunity: they ask you to sign forms at every stage indemnifying them. They are always offering you some wonder drug or other that will solve everything and will cost lakhs and lakhs. And after you have spent 40 or 50 lakhs and you are exhausted, they hand you a dead body and tell you to get out.”

Our coffee cups are cold.

Shibani and Amit are nodding to themselves. There is something remarkable about the complicity between these two cousins. Shibani is so meek in her appearance, and yet so powerful and impressive.

“You did everything you possibly could for your mother and for your aunt,” I say to them. “That must have meant something to her.”

Shibani glances at Amit.

“Actually we are not cousins,” she says. “We are in a relationship. But since we are not married, no one thinks I can play a legitimate role in this story of Amit’s mother, so we say we are cousins. The first doctors said to me, ‘She’s not your mother and you are not married to this man, so who are you to care for her?’ But I had to take care of Amit’s mother, because he was working.”

Aarti is surprised at this twist in their story, but she says nothing. The coffee grinder roars for a few seconds in the background. Everyone waits patiently through the silence in our conversation, not wanting to move.

Aarti says, “My husband was a tango dancer, a waltz dancer, a sportsman. He was a very hearty man. He was in love with life. When things started going wrong, he said to me, ‘If my legs go, I don’t want to live anymore.’ I said to him, ‘I’ll take care of you. We’ve been blessed with forty-three healthy years together. What does it matter if one of us is sick now? We can go on for many years more. I will give up everything to take care of you.’

“That’s what I did for those three months. He was never left alone. I never let them park him in a corridor which is what they always do. I said, ‘He is not queuing in a corridor on his bed where everyone can stare at him. He will stay in his room and come down when the doctor is ready.’

“But at the end, when I went into the intensive care unit here and saw him full of pipes I broke down and I said, ‘Go, go, my love, don’t stay in this world anymore. This is no life for you.’ And I took him out of there and back to his room. And I put on some beautiful devotional music from our Sikh tradition and I massaged his head all night. He was at peace, he was not grunting or making noises. He just slipped away. I stayed with him all night — but he did not die then. He knew that if he died, I would be left all on my own. He waited until the next afternoon, when everyone was there around us and he knew he could leave me with people who loved me. Even in death he was so considerate.

“I gave him a beautiful death. In all of this, that’s my only satisfaction.”

Aarti speaks with great matter-of-factness about all this. There is no outward emotion — except, perhaps, a certain zeal, for she is a woman in whom adversity releases great retributive energy.

“For forty-three years,” she says, “he gave me roses every Valentine’s Day. Once when we were in Bombay and he couldn’t afford twelve, he bought six. Other years he bought twelve or even twenty-four.

“This year I was talking to my sister in London and I said, ‘I’ll have to get used to not having roses on Valentine’s Day.’ But on the fourteenth, I arrived home in the evening and there was a massive bunch of roses from her. Her note said, ‘Aarti, he never left you. He will always love you. These are from him.’”

• • •

For most people in the world, medical adversity represents the greatest source of financial crisis, and India has never been any different. Until liberalisation, however, the cost of healthcare was lower by several orders of magnitude, not only because doctors charged lower fees, but also because the whole business was significantly less technologically intense. Magnetic Resonance Imaging (MRI) scanning machines, for instance, were rare, and most doctors made their diagnoses without access to expensive tests of these sorts. Drugs and therapeutic equipment, similarly, were both more rudimentary and cheaper before liberalisation allowed the entry into India of the world’s major pharmaceutical companies. So if serious health problems inevitably presented periods of financial stress, the cost levels were such that middle-class people could usually meet them by pooling the resources of family and friends.

The system worked also because doctors had high levels of prestige and credibility. While many government hospital doctors supplemented their income by offering private consultations at home in the evenings, in the hospital itself they worked for a fixed salary and had no financial stake in the diagnoses and treatments they offered. Their medical judgement was, in their patient’s eyes, uncompromised. There was every reason to feel secure, when consulting a doctor, that his or her interest was similar to one’s own.

After liberalisation this equilibrium was significantly disrupted. Government hospitals had by this time become conspicuously under-resourced, and the middle classes flocked to the new corporate hospitals. But the costs here were such that, in the case of the most extreme and drawn-out of illnesses, even affluent families could stand to lose everything they possessed. And though the middle classes began in the same period to invest in the new health insurance packages offered by private financial institutions, these were often adequate only for relatively minor treatments. Even the most comprehensive of them excluded treatment for several chronic diseases — various kinds of cancer, all illnesses resulting from HIV, anything at all that struck past the age of sixty-five — and total re-imbursement in one year to any one patient was usually capped at a relatively low level, usually between $5,000 and $20,000. The most devastating financial territory was entirely unsecured.

This already-dangerous situation was exacerbated by the new suspicions introduced by the conspicuous profit motive of corporate hospitals. There was no doubt that these institutions were corporations : they looked like corporations, they expanded — and bought and sold each other — with corporate speed, and they were administered by some of the country’s major financial interests. Patients in these hospitals were fully aware of the aggression with which big Indian businesses operated; they also knew that corporations were something of a fiefdom, whose practices went largely unscrutinised by any independent body — and they were therefore racked with uncertainty as to the nature of what was happening to them. Was this expense necessary to treat their condition or was the corporation simply trying to suck up their money?

As everyone knows who has moved from one country to another, the last thing one becomes accustomed to is a new healthcare system; and the shift to this new healthcare regime in India would have produced suspicion even if its integrity were beyond reproach — and in many cases, of course, it was. But there was considerable disquiet within the medical establishment too, and many doctors confirmed that the storm in patients’ heads was not only in their heads. A surgeon from a leading government hospital felt that his entire profession was under threat from the new corporate hospitals.