Rana Dasgupta - Capital - The Eruption of Delhi

“They are money machines,” he said. “They are about revenue maximisation, pure and simple, and they have led to a dangerous collapse in medical judgement and ethics.

“Let me give you an example. A leading surgeon left his job at the government hospital where I work to join one of the big corporate hospitals. He was offered a salary of 2.4 crores a year [$480,000], which was ten times his previous salary, but it was dependent on him delivering 12 crores [$2.4 million] of revenue to the hospital. Now, if he did the maximum possible number of operations in a year, he still would not deliver 50 per cent of that figure. So the rest had to be delivered by diagnostic tests. Which is why there has been such a huge escalation in tests. Patients are sent to do repeated MRI scans so that doctors can meet targets. Some patients have very high radiation exposure as a result of all this.

“Certain surgical procedures are carried out almost without indication. Anyone who has upper abdominal pain has their gall bladder removed. Forty per cent of these procedures are unnecessary. But the patient doesn’t know that. It’s usually not possible for a patient to find any evidence of malpractice.

“Look at the rates of Caesarian section. Some of the most famous obstetricians deliver 70 to 80 per cent of their babies by Caesarian. There is hardly a hospital in this city that offers a natural birth service. Why? Caesarians make more money than normal births, of course, but more importantly they allow doctors to determine the schedule and to fit more women in. It’s much more efficient.

“The pharmaceutical and medical equipment industries have a huge role in deciding treatment options because many of these doctors are working directly for those companies, which the patient doesn’t know. Drug companies pay many oncologists 10 per cent of the value of the chemotherapy they prescribe; a typical figure would be a crore [$200,000] of prescriptions a month. Cancer of the pancreas is a favourite, because if you get to the stage where you need chemotherapy you are anyway going to die within six months, so doctors can prescribe whatever they like.

“These hospitals are very dark institutions, even at the business level. Land is acquired for them by the government at an enormously subsidised level, and often the government donates money towards the cost of setting up the hospital, on the condition that it allocates a third of beds to the poor. But the hospitals never honour such commitments: there is no question of them writing off those kinds of profits. Later on, they sell a share of their company to the public for hundreds of millions of dollars and the newspapers laud them as self-made billionaires. But their fortunes were built largely from public money.”

He talks calmly, but with brimming outrage.

“You should write your entire book about this,” he says to me. “I can’t do it because all these people are my colleagues. But someone needs to write about all this. Pose as a patient and see what happens. Start telling people you need to buy a kidney and see where you are led. In my hospital I worked with an anaesthetist who was involved in a big kidney transplantation racket in Delhi. Kidney transplantation is very easy: you can do it in a normal flat. And India is the diabetes capital of the world, so many people are proceeding inexorably towards end-stage renal disease, which is completely wretched. Add to that a lot of poor people willing to sell a kidney and the outcome is obvious.

“The whole industry has become very sinister. Where does it find its cadavers, for instance? With all these new pharmaceutical companies and research laboratories, demand is growing on every side. Tissue banks need cadavers. Every company that manufactures implants needs to test them on cadavers. Now, the Mysore Anatomy Act of 1958 says that only unclaimed cadavers can be used for medical experimentation. But large-scale entrepreneurial medicine needs far more than this. So now you have bodies being stolen everywhere. They disappear from funeral homes and end up in surgeons’ colleges and corporations.”

I tell him how I recently met a man who supplied cadavers to a dental college. I asked him where he got them from and he told me he fished them out of the Hindon river, a tributary of the Yamuna. He just sat by the river every day waiting for corpses to float down.

The doctor smiles.

“That river flows through Ghaziabad. A lot of those people whose bodies end up advancing dental careers would have been killed in property wars. Bumped off by rivals. It’s an appropriate image for Indian medicine today. Taking the chaos of our society and turning it into profit.”

A man is telling me about the decline of his marriage. Part of the story is an affair his wife was having at work. From the way he tells it, I do not quite believe in this affair. I make the statement deliberately bald to see if he will stand by it.

“So she was having an affair,” I say. “That must have been—”

“At least I thought she was having an affair—”

“You thought she was having an affair?”

“She thought I was having an affair. So I thought she was having an affair.”

I realise that he knows perfectly well she was not having an affair. But he thought it all the same, as a form of revenge.

Discontent was a persistent irritant in Delhi during this period, like a bad spice lodged in the city’s proverbial belly.

Often this discontent was of a very material and obvious sort. The group of people who felt that the serene, propertied lifestyle depicted in advertising campaigns was intended for them — a minority of the population, certainly, but a substantial one — came to realise that life in the new India did not automatically turn out like that. The carefree adults, the sprawling kitchens, the moneyed youth — none of this seemed to come as easily as one was led to believe. In fact, it grew to seem more and more remote, for property prices rose more quickly even than good middle-class salaries.

This particular kind of discontent was sharp. The middle classes had a strong sense in those years that wealth was their due: it had been promised to them. And it had been promised now: this was India’s moment, and it might not come again. This explains those newspaper articles during that period which documented ‘unconventional’ middle-class money-making: the students who supplemented their income by theft or prostitution and, much more widespread, those entrepreneurial corporate employees who found ingenious ways to redirect company money to themselves.

But there were many other forms of discontent too, and if these were more inscrutable, they probably had a more profound and distressing effect on people’s lives. It was clear for instance that the family — that symbolic mainstay of Indian society, in whose name so many people embarked on this fury of accumulation in the first place — was under enormous stress. It was as if the torque of the new system was exerted asymmetrically on parents and children and, in particular, on men and women: the various units of the family were wrenched in different directions, and bonds deformed and broke. Nowhere was this more visible than in middle-class marriages, which were exploding in those years like so many nuptial firecrackers.

• • •

“I think it would have been better if my husband and I had lived separately from his mother,” says Sukhvinder. “At least there wouldn’t have been so much constant bickering. And I think my husband would have been a little bit more open to new ideas. He was very stuck living under that roof. He did what he had always done and in the way he had always done it. The word ‘change’ did not exist.”