Tuesday, June 18, 2013

Settling in the Garden City: Bangalore

Last summer, I spent many Thursday evenings eagerly waiting for my father to arrive from work. We would have dinner and then promptly plop down in front of the iPad. Our Thursday ritual was watching the Al-Jazeerah Network’s Indian Hospital, a documentary about Narayana Hrudayalaya (now renamed Narayana Healthcare this month), one of India's biggest multi-specialty hospital chains that uses large economies of scale to bargain down the cost to supplies and care. The institution, situated in Bengaluru, India, is able to offer holistic healthcare at a fraction of what it costs across the globe, while remaining a world-renowned institution for care that is both profitable and growing business. Typically, most healthcare institutions are geared towards making money. This one is geared towards serving the socioeconomically disadvantaged. I was touched by the story of an almost paralyzed man who received a cornea transplant despite his deteriorating condition. While he was almost paralyzed, creating music was his passion, so his ability to read music was essential. It wasn’t long before I was enamored. I told my family that I would one day visit the place, and today, here I am!

I would like to thank our generous sponsor and everyone at the Center of South Asian Studies that made this opportunity possible. My objective is to research how the practices of this hospital have changed the lives of socioeconomically disadvantaged patients. Dr. Paul C. Salins, director of the Mazumdar-Shaw Cancer Center and Dr. Biju Jacob, Head of Research have been mentoring me throughout my journey. My journey to the hospital begins early in the day. While the hospital is on the outskirts of the city, I am staying closer to the center, which means a grueling one and a half hour journey each way. In the beginning, my work was predominantly to gain an understanding of poverty. Dr. Salins quickly decided that the best way to do that is to experience it firsthand. I arranged a visit to the Biocon Foundation, an organization that has health clinics all across rural India. The foundation offers an insurance scheme to patients that make a certain amount of income. The scheme covers outpatient visits in the clinics available and treatment at tertiary centers like Narayana Hospital. My site observation was at the Biocon Foundation at Houskur, Karnataka. To truly understand poverty, Dr. Salins asked me to understand the structure that an Indian family typically takes, the family dynamic, the kind of support that a community offers to a family, and the costs that are associated with an illness when a patient does or does not have a microinsurance scheme to support them. I met Ms. Gracy Thomas at the Biocon Foundation and we took a company bus to the site. The clinic was situated in front of a temple, and I quickly got to know how important religion and rituals were to the community.
Hindu temple in front of the clinic

The Arogya Raksha Yojana  clinic in Huskur that has a comprehensive health insurance plan and subsidized medicines that offer the people of rural India affordable access to high quality healthcare.
Unknown to me na├»ve me, the pool of red on the floor that everyone was trying to avoid stepping in was not some sort of festive colorful dye, but blood from the 24 goats that were sacrificed the day before for a festival. My first day there, I did not get to have very much interaction with patients because many were either involved with the festivities going on or tending to their crops because it had rained the day before.  My subsequent visits provided me with more insight about the residents of Houskur and poverty in general. I found out that agriculturists made up 70% of India’s work force. In Karnataka, India, the state where Nayarayana Healthcare Hospital is, this statement holds true despite the fact that the land is not very fertile.  To aid these agriculturists, the government and companies such as Biocon have created different microinsurance schemes that allow farmers and patients below the poverty line to have insurance that costs from about 10 US cents a month to nothing. Despite this, there are many who have not enrolled for such schemes and cannot reap the benefits. When an illness hits families without coverage, the result is debilitating—families are left in poverty with no chance of escape.

During my site visit, I also learned that joint families are a commonplace in India. Homes are multigenerational so that children can more easily take care of their parents physically and financially. However, this is not always the case. Like any family, tensions can arise, which makes support hard to come by. When this happens, families have to resort to borrowing from sources such as private money lenders that sometimes charge 100% interest. For a family that is already poor and desperate to keep their loved ones alive, the choice is difficult. I learned that while the cost to treat a child or an adult may be the same, the effect on the family can be very different. When a child is sick, the net income may not take a hit as bad as if the breadwinner is the patient. I also found out more about the microinsurance schemes that exist. When a patient does not have a microinsurance scheme but seeks treatment, hospitals such as Narayana may have philanthropic care to offer them. However, there is still a fee (approximately 40,000 rupees or so). If the patient cannot pay this subsidized fee, does not have a microcinsurance scheme, or the hospital simply cannot handle the volume of patients that need philanthropic care, the patient has no choice but to go home. Even with a scheme to pay for treatment, families still experience burden both financially and emotionally. Many of the schemes do not cover all aspects of healthcare. Oxygen, ventilators, stents, and chemotherapy are just a short list of necessities that are not included in schemes. Additionally, patient’s families must arrange for lodging, food and transportation when their family member is sick and that oftentimes also means that they cannot be earning while looking after their loved ones. My next plan of action is to draft a questionnaire and speak with researchers to understand how to ask sensitive questions and get the information I need.


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