The Commune: Systems of Care

Dear friends,

I went to a public hospital, a few weeks ago. Spread over a hefty acreage one would imagine that this old hospital was once spacious, therapeutic and open with sprawling trees and chirping birds. When I visited though there was a constant honking of too many vehicles lined up bumper to bumper and the tussle of too many bodies swarming towards different buildings. After the enforced isolation of the pandemic, I must have forgotten just how many people there are in this city. In the garden islands, women and men sat on bedsheets, baskets carrying food, water and other supplies flanking them on multiple sides. Synchronous hands moved like fans to make the warm summer day bearable. Heads were covered, eyes were shielded using any form of contrived shade. The patience of the poor and the desperate it seems is infinite. Inside the Trauma Centre, I watched in suprise as a man with a trailing IV wandered like a lost ghost, pale with large eyes, knees bloody, looking for a nurse presumably. At the scanning centre, a group of people were bickering. The CT Scan machine had stopped working and lines of patients sat or lay in wheeled beds, catatonically with infinity in their eyes.

I am not sure what I had expected. I have been to countless public hospitals over the years and these scenes are common enough. So as I sat midst the crowds, awaiting my turn, I pondered. We had just been through a tremendous crisis, a pandemic. Two years of turmoil and relentless uncertainty. Nothing puts a strobe light on the whole public health system like an emergency. I think back on heart-breaking snapshots of endless lines twisting out of hospitals, the desperation for oxygen, the panic of not being able to breathe – and then come back to this. How is this different? And immediately it is evident – the people are different. For a brief period of two years every person, irrespective of class, in their own way felt the failings of the public health system. Now it was back to being the experience of the poor. India’s own Economic Survey 2021 pointed out that India ranks 179 out of 189 countries when measured for health prioritisation in government budgeting, similar to nations like Haiti and Sudan that are largely dependent on aid. It also points out that India has one-of-the highest level of Out-Of-Pocket Expenditures (the expenses that the patient or the family pays directly to the health care provider, without a third-party – insurer, or State) leading to the high incidence of steep expenditures and poverty.

As economic growth again takes centre-stage and begins to drive the country into the post-pandemic world, I wonder at the fragile promise of new imagination that was on offer, that continues to be on offer. The pandemic world whispered such profound stories of how each of us is not only connected to other humans but also to other creatures who inhabit this planet. “Tug on anything at all and you’ll find it connected to everything else in the universe“, wrote environmentalist John Muir. How can we imagine a world of genuine well-being when most of us do not have equitable access to basic healthcare?

What else do you think is essential to building a world pivoted on well-being? Do share your thoughts with us. We look forward to them!


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