The State of Public Health in India (original) (raw)

2016, Unsung: Extrodinary Lives

I had been a medical student for three years when it dawned on me that I was not cut out to be a clinician. I had begun to understand that medicine was about disease and illness and not necessarily about health and well-being. It was becoming apparent to me that a health system that considers and addresses social, economic and political realities of individuals and communities was the one likely to be most effective. Though medical students were required to study and intern in community medicine, our studies did not include an exploration of these non-biomedical determinants of health. It was the eighties, and there were no schools of public health in India at that time. After a few years of experimenting and drifting I chose to specialise in Radiology. It was perhaps in 1985, while a medical student, that I happened to hear a BBC reportage on doctors providing medical humanitarian assistance to those affected by famine in Ethiopia. The programme profiled the activities of Médecins Sans Frontières, also known as MSF or Doctors without Borders, and the incredible challenges they faced in providing assistance. Until then, I had only met doctors who practised in urban areas and whose lives were, without a doubt, comfortable. That much was taken for granted. But I liked what I was hearing about doctors going where assistance was sorely needed. These were the days before the internet; I wrote to BBC World Service, asking for MSF's address. Two months later, I received a note with MSF's address in Paris. I duly typed out a letter, offering my services as a volunteer, and sent it off to MSF. I never heard back. Years later, after a year of training—I had decided that Radiology was not for me either. I dived into public health. Public health proved to be a good bridge from science to the social sciences. And, it was intellectually stimulating. In 1994, I was given the opportunity to intern at the University of Natal, with a team working on certain aspects of health policy for South Africa under the new presidency of Nelson Mandela. On my way back from South Africa I bumped into someone who worked for MSF at the airport in Brussels. We chatted for a while and he suggested, as he left, that I should be a 'Doctor Without Borders' and volunteer with MSF. Soon I found myself in Ethiopia, setting up a tuberculosis control programme for Somali pastoralists in the Ogaden desert. To be able to offer health services regardless of political, racial or economic conditions in remote and crises-affected parts of the world has been one of the most satisfying journeys in my life. Now I stand convinced that healthcare cannot be about medicine alone and that health and the delivery of health care cannot be left to the mercy of market forces. Health is a public good and governments have the responsibility to ensure that their citizens enjoy and are afforded a certain level of care that allows them to thrive and be functional members of society. Governments must therefore remove barriers to access so that those who need health care the most receive it. After almost two decades of medical humanitarian practice, I decided to take a year off, for much needed rest and recuperation but also for some reflection. As a medical intern in 1988, I had joined an Himalayan expedition that cycled 2,600 km from Delhi to Leh and Srinagar and back to Delhi. I had always wanted to 'complete' that journey by cycling all the way down South. So twenty-five years later, I set out from Srinagar, on a cold rainy day, on a 5670 km exploration of India. I was keen to see how the country had changed since I'd last cycled the roads of north India. I wanted to hear how people across