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Indian Journal of Surgery, Vol. 65, No. 1, Jan.-Feb. 2003, pp. 17-19 Presidential Address Changing Face of Health Care and Our Responsibilities Shashanka Mohan Bose President, Association of Surgeons of India Code Number: is03001 Presidential Address delivered at the Inauguration of 62nd Annual Conference of A.S.I. at Kolkata on 27th December 2002 It is a matter of great honour for me to stand before you all as the President of this great Association-the Association of Surgeons of India. My joy is further heightened as I am presiding over the 62nd ASICON in Kolkata, the City of Joy and the capital city of Bengal. I was born and brought up outside Bengal, the great motherland of Tagore, Subhash, Bankim, Vivekanand and others but my roots are here. This has humbled me further with all the humility at my disposal. Friends, today I am going to talk to you on "Changing Face of Health care " and our duties and responsibilities in this scenario. We have just entered the 21st century and if we take stock of the last century, we can safely conclude that the last quarter of century was totally dominated by a series of creditable scientific advancements, nail biting technical developments and an unimaginable information explosion that took both medical education as well as medical profession by surprise, The strides of alterations, including the technical know how, has been so rapid and astounding that it virtually benumbed the intellectual capacity of any and every medical professional. The transitory turnovers have been so vivid and rapid, that what was relevant in the preceding year in terms of technical up gradation turned out to be obsolete in the very succeeding year. This resulted in a total transformation of the face of medical education and techniques of health care delivery system. India has not lagged behind and there have been mind-boggling scientific and technical advancements in our country also. But in the backdrop, if we take stock of the health services in our country from their quality as well as humanitarian point of view, its track record is palpably questionable and disputable too. This is because of the indifference to the suffering humanity, both by the government and also by our professional brethren, possibly due to mute social sensitivity and dying and decaying conscience of ours. Health is a subject of very low priority in our country, the budget allotment is mere 1.5% in contrast to 15 -20% in USA and other developed countries. In Canada, Australia, the medical care is totally free for their nationals but in India nothing is free for anyone, even in government institutions like PGI, AIIMS. The result is therefore obvious. It is well known that presently the health care delivery in our country is based upon the financial and social status of the patient. If the patient is rich or well connected then he can get the best care that can be obtained anywhere in the world but if he is a poor man then God can only help him. The " value based " surgical profession has been totally transformed into a "price oriented system " out of the guiding forces of the market economy within the annals of the principles of sale and purchase. This has grossly eroded the ethical component of our professional conduct at the behest of materialistic orientation Can a poor man or even a middle class person of our country have any resource at their disposal to gain a first hand access to the so -called advanced surgical health care; can he afford a renal or liver transplantation, can he afford coronary bypass or surgery for brain tumour. Can he afford second level chemotherapeutic drugs, can he afford hip or knee replacements? No, he cannot, so the alternative is to decay and die. This is so, inspite of the fact that we had resolved to constitute ourselves into a welfare state vide our constitution, whereby every citizen was guaranteed life, liberty, equality and fraternity. Five and half decades of post-independence era have demonstrated that we have miserably failed in providing a healing touch to the suffering multitude of our country. About 7% of seriously ill patients leave the portals of PGI, a government hospital, because they cannot continue to afford the cost of health care delivery system. The number is obviously much more in the private hospitals. It is not only the finances, which determine the quality of treatment but also the geographical location of the patient, which is directly linked. In India we have surgical centers of excellence with state of art facilities and we have centers where even perforated duodenal ulcer, extradural haematoma, fracture cannot be treated. Effective referral system does not exist and therefore, the patient either falls prey to quacks or reaches a competent surgeon at a very late stage. But this cannot continue like this. Awareness of the rights of the patients is being increasingly felt. The rights of the patients are a clear reflection of the cultural, political, economical and social change that has taken place in our time and medicine cannot ignore this. The finger is being pointed not only to have the treatment but also to have the right type of treatment. A patient of early breast cancer can always ask a surgeon why she can not have breast conservation surgery, or why a patient of cancer rectum can not have his sphincters preserved, particularly when the results are the same. This can produce complications in the doctor-patient relationship. In India, doctor has been treated next to God, but if we have to remain at that high pedestal then we have to make ourselves suitable for the honour. It is not only the type of treatment that the patient has a right to know but also the investigations that are being carried on his person. Why should not a patient of trivial head injury have CT scan of head or why should not a lady regularly have a routine mammography. The reverse is also true, i.e. repetition of unnecessary investigations. Why should you order for CECT or MRI of abdomen in a straightforward case of Cholelithiasis; or why should you repeat a total Body Scan in a patient of Breast Cancer within a period of couple of months. I will not be the first person if I say that a number of investigations are carried out not because they are indicated but because of non-professional reasons. I therefore, plead to all of you assembled over here to take cognizance of the concept of service before self. We are capable of evolving ways and means to render the required healing touch, in the name of humanity to the suffering multitude in the present millennium. We have to work out the modalities so as to bring down the cost of surgical care. We should not forget that we are not living in USA or Saudi but in India where 40% of our people live below the poverty line, and every rupee saved can help another deserving patient. All of us have to review the doctor-patient relationship, remember the CPA creates problems only when we forget or neglect our responsibilities. In the Gita, Krishna tells Arjuna: "Your right is only to perform your duty, but lay no claim to its fruits. You should neither scan the result nor lean towards inaction. " Friends, another aspect of our health care delivery system that I shall like to interact with you is the graying of our population. Eighty or ninety years old and even the centurians are no longer a source of wonder. This is what is known as graying of the population. These elderly people not only want to live well but they have to be cared in a special way for their health care needs but is the society geared to meet their specific needs, I am afraid the answer is in negative. Most of the developing countries are not in a position to provide the social support and unfortunately the changing social system has alienated the off springs from their parents. The phenomenon of elder abuse is spreading at a very rapid pace and older people are now regarded as a burden on the younger sections of the community. The health care of elder citizen although is a moral and ethical obligation but practically it has become a social problem, the answer for which have been eluding all. Friends, the above mentioned facts have been bothering me for quite sometime now, I have discussed this in tit bits on a few previous occasions when I happened to be with you in your state chapter conferences but I thought of putting this in a consolidated form for your considerate thought, analysis and for your active action. I shall like to quote the clarion call of Swami Vivekanada " Awake, arise and Act " Each one of us will have to ponder over these points and try to find out a solution so that health care is provided to each and everyone in equitable manner irrespective of caste, creed and financial or social status; then only we can proudly say that we belong to India, a true democratic, socialistic country. I again quote the Gita: "Treating alike pain and pleasure, gain and loss, victory and defeat, engage yourself in the battle. Thus you will incur no sin ." Ladies and Gentlemen, thank you once again for giving me this opportunity of being the President of ASI. I wish you all a very successful and rewarding surgical career, a very peaceful and enjoyable family and social life. May God bless all of us with skill in action and compassion in nature; and thus make each one of us a true Yogi; and to bless all of us with steadfast wisdom to do our duty unaffected by success or failure and then only we can call ourselves True Surgeons. Long live India. Long live A.S.I. Copyright 2003 - Indian Journal of Surgery. Also available online at http://www.indianjsurg.com |
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