Cleaners act as doctors in rural Indian hospitals
A hospital cleaner gives an injection to a young accident victim. A ward boy stitches wounds. Mangy dogs roam the hospital corridors.
The scenes in a pair of impoverished rural hospitals, captured on secret cameras and broadcast by TV news channels, sparked outrage in India, with critics contrasting the incidents with the luxury health care enjoyed by India's rich.
The TV reports last week sparked calls for an investigation and sackings over unqualified staff performing doctors' tasks in the emergency wards of government hospitals in Ballia and Bulandshahr in Uttar Pradesh, the country's most populous state and one of the most backward.
Neither the sweeper nor the ward boy wore gloves in the clips. In the Bulandshahr hospital incident, the chief medical superintendant looks on as if he is witnessing a routine practice.
Initially, Uttar Pradesh health officials tried to justify the incidents by saying that all the staff had to 'pitch in' during a sudden influx of patients to emergency wards. Later, the government retracted the comments and ordered an investigation.
For the more than 800 million Indians who live on less than US$2 a day, there is no choice but to go to a government hospital when they fall ill because the treatment is free.
'The poor avoid going to hospital as much as they can. They know they'll be lucky to be treated, lucky to find a doctor,' said author and social commentator Satish Jacob.
At the Bulandshahr hospital, 23 doctors were registered but hardly any were captured by the hidden camera. Beds are shared by two patients, lying head to feet. The toilets are dirty, the kitchens just as bad.
'When they go to the pharmacy with their prescription, the person behind the counter invariably says he doesn't have most of the medicines,' said Omkar Nath, a pensioner who collects medicines donated by the rich to distribute to the poor.
'That's because they have sold the supplies for a profit. The patient's family then has to go to an outside pharmacy and buy them.'
At the other end of the spectrum, top private hospitals in India resemble luxury hotels with Italian marble and opulent interiors. The air-conditioned suites are spacious, with upholstered sofas, flat screen TVs, i-Pod decks, a choice of pillows and cafes serving lattes and bruschetta. The medical care is world class.
A maternity hospital, Fortis La Femme in Gurgaon, just outside the Indian capital, boasts rooms costing up to US$3,000 a day.
Rural government hospitals sometimes lack even basic facilities, and are certainly ill-equipped to deal with complex cases. Poor patients requiring complex care are forced to travel by train for days to the All India Institute of Medical Sciences in New Delhi, the facility regarded s the best government hospital in the country.
In an attempt to improve care for the poor, the government recently announced that it would provide free generic medicine in all government hospitals from November.
Although the Uttar Pradesh videos prompted howls of outrage, some health experts said the critics failed to take into account the reality of medical care in rural India.
They argued that, if properly trained and supervised, poorly educated staff such as ward boys could improve care by performing routine procedures, working as midwives, or dealing with cases of malnutrition.
'The concept of 'barefoot doctors' [health volunteers] which was pioneered in China is the model we need to follow. Rural India is not Manhattan. It makes sense for ward staff to be taught to give basic care. The alternative is to leave patients unattended,' said retired doctor Dr Mukesh Ghosh.