An Enviable Problem

Our team has landed in Mumbai just fine. I never sleep well on planes. I have tried numerous times, but I've always failed. At this point, I've given up. But, I've started to look forward to flights. It's perhaps the only moments where my time is entirely protected. There's nothing to do but sit. And, at least, it gives me moments to think.

I flipped through old New Yorker's on the flight (they've been collecting dust on my desk for so long- guilt goaded me to bring them along). I read through the article: "Testing, Testing" in the December 2009 issue. It discusses the necessity of overhauling the current American health care system and critiques the current proposal on not substantially changing the nationwide healthcare structure so that it curbs costs and raises quality. It really cannot be argued that "the [proposed healthcare] bill doesn't even meet the basic goal that the American people had in mind and thought this debate was about: to lower costs". This quote was said by Senate Minority Leader Mitch McConnell, and noted in the "Testing, Testing" New Yorker article by author Dr. Gawande.

I won't deny that the U.S. healthcare system threatens this nation's financial solvency, nor do I argue that it is in major need of change to curbs costs. But at least there can be reasonable discussion over this. In contrast, India, as far as I understand it, has very little health care to even speak of. It would be a wonderful boon were India to be able to participate in the same discussions. India's health care system is instead much simpler; those who have money receive excellent care, and those who don't, don't.

Arivand Adiga's White Tiger was perhaps one of the novels that best described the struggles of India's abjectly poor class. In the novel, under the guise of government aid, hospitals would open to treat those who couldn't otherwise pay, but these were empty promises. Physicians didn't staff these buildings, as economically, it makes very little sense to treat India's truly poor. But these aren't just stories from novels. My cousins, who live in India still, have relayed many similar stories as well.

Even for my Aunt in India, medical care was hard to come by. She was middle class, but found medical care poor at best after being diagnoses with small cell lung cancer. Routinely, she would make a four hour trip on train to be treated, only to find that there was no chemotherapy still available. Without financial aid from others, even when treatment was available, it still would not have been available. My aunt passed away from complications of her cancer three years ago now. Although her passing from this aggressive malignancy was pre-ordained, there were many steps where the rudimentary medical structure in India failed her along the way. For what it must be like for the abject poor, I cannon even begin to imagine. I an only glimpse at it through aforementioned works of fiction. But I know that fiction is only an extension of actual medical problems.

So, while the U.S. focuses on cutting health care costs, I think that India would be so fortunate to have such a problem. So much is there to be done. Clean water, a trauma response system, and further outreach to the poor would just be a start. Regarding burns, simply the initiation of a central registry would dramatically improve the ability to identify at risk individuals and work on methods by which to educate these groups.

The flight's over, and it's time to get to work! As mentioned, there's much to do.

Patient screening starts today. Thank you very much for reading.

Indranil