Addressing Inadequate Healthcare Infrastructure in India’s Rural Areas

Addressing Inadequate Healthcare Infrastructure in India’s Rural Areas

June 8, 2021 | Author: Dr. Kanwaljeet S. Anand, ICU Physician, Stanford University Hospital

When her husband died from a snakebite in the fields, Venkamma went to live with her eldest son and his family. Within the few days of mourning, she had to adjust to her new station in life.  Means were limited, food was scarce, and she was now just one more stomach to fill. But with humble gratitude and a ready smile, she made herself useful. Venkamma looked after her grandchildren, worked in their vegetable garden, helped with household chores, and worked in the fields during the sowing and harvesting seasons. Earlier this year, she had started feeling weak and losing weight, despite her increased appetite and intense, insatiable thirst. The same inconsequential tasks now seemed almost insurmountable, and she was worried about a mounting sense of resentment in her son and daughter-in-law. 

Until one morning, she simply did not have the energy to get out of bed.  A concerned neighbor and well-wisher told her son to take his mother to the doctor, but he was reluctant because medical care was expensive, and it was available only in the town of Chikkaballapur only in exchange for hard cash. On his way back from the market, another farmer had told him about a large clinic located in a nearby village about 20 kms away. The farmer had heard that all medical visits, blood tests, and even the required medicines at this clinic were given free-of-cost. In fact, this clinic did not even have a cash counter, and no one had asked them for money. Her son begged the village shopkeeper to take him and his mother on the motorcycle to this clinic. 

The next morning, the three of them arrived at this large, bustling clinic in the village of Muddenahalli.  The trip was exhausting and Venkamma had to be supported/half-carried into the facility. A kind nurse saw her and immediately took them into a clinic room. An elderly doctor soon came and started asking her health-related questions, while telling the nurse to get some blood tests. Another doctor came and looked in her ears because she had suffered earache for the past week.  At the end of that visit, Venkamma was diagnosed with Type 2 Diabetes, mild Hypertension, and an ear infection.  She was started on appropriate medicines that were supplied free-of-cost, she received detailed education from a Diabetes nurse and a dietician, and, by the evening, she was feeling much better and ready to go back. Her health and energy levels improved markedly over the next two weeks; she stopped losing weight, and soon she was back to her usual household activities. Her son and daughter-in-law had also realized how valuable she was to their household, and they gave her the respect of being the elder of their family. 

I met Venkamma in the out-patient waiting room about a year after she had been diagnosed with Diabetes.  She was back to her sprightly self, ready with her bright smile and helping hand. She regularly came to the out-patient clinic in Muddenahalli, where she received all her medicines and other types of health care (nutrition advice, physiotherapy, dental care, gynecologic screening, etc.). To me, she declared that no one had ever asked her for a single penny and that she got the highest level of respect and regard whenever she was here. In fact, she admitted that her son saw how she was treated at the clinic and changed his behavior to become more respectful after their first visit. 

Since then, I’ve learnt the stories of many more villagers with similar life situations and health problems as Venkamma. This busy, multi-specialty clinic routinely examines more than 150 patients each and every day, usually 60-70 men, and 80-90 women. Most of these patients (80-85%) are from rural areas and none of them have ever received any demands for payment.  Many of the patients come in for chronic conditions such as Diabetes and Hypertension (or both), but some also have cardiac problems, need Gynecology, ENT, Ophthalmology, or Dermatology services. A few patients also come for dental care, obstetric or pediatric care, or minor surgeries and trauma, which are generally performed under local or topical anesthesia. 

The COVID-19 pandemic has brought the inadequate healthcare infrastructure, particularly in rural areas into the sharpest focus. The local trust decided that this busy out-patient clinic must be expanded into a full-fledged, multi-specialty 150-bed hospital, designed for and dedicated to serving the rural poor, who had no other source for quality, free-of-cost medical care. I visited this construction site in February and March this year and walked through all four hospital wings, then, in various stages of completion.  The thoughtfulness and cultural sensitivity with which this hospital was designed and built simply amazed me beyond words!  When the second wave of COVID-19 infections swept through India like a tsunami, the number of confirmed new cases quickly mounted up to more than 400,000 per day, and the number of COVID-related deaths exceeded 4,100 per day in early May. The WHO reported that these numbers are grossly underestimated and mostly reflect the prevalence data gathered from towns and cities – the number of cases and fatalities in rural areas are several-fold higher.  However, even during pandemic lockdowns, Venkamma and other patients continued to receive their medicines and medical supplies hand-delivered by volunteers to their huts and homes in remote villages.

On May 7th, The Deccan Herald reported that Chikkaballapur is one of the seven districts in Karnataka that quickly ran out of ICU beds, oxygenated high-dependency beds, and even regular hospital beds and routine medicines. Karnataka reported more than 440,000 active cases, with needs for over 13,000 ICU beds (700 available) and 75,000 oxygenated beds (22000 available). This hospital was expressly repurposed into a COVID-Care facility, with 125 high-dependency beds and 25 ICU beds, to serve a population of 1.3 million people from 1,515 villages.  Despite the pandemic-related limitations, hospital construction was moved forward to a war footing and the hospital is targeted to open its doors by Saturday, July 24, 2021.  I hope and pray that Venkamma and the others that I met at this clinic have survived the carnage and chaos of the current pandemic – but take solace from the fact that, very soon, at least one rural hospital will be providing compassionate, competent, cost-free care to all.

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Dr. Kanwaljeet Anand graduated from M.G.M. Medical College, Indore (India). As a Rhodes Scholar at University of Oxford, he received the D.Phil. degree, followed by post-doctoral fellowship at Harvard Medical School, Pediatrics residency training at Boston Children’s Hospital and a Critical Care Medicine fellowship at the Massachusetts General Hospital, Boston. Dr. Anand is currently Professor of Pediatrics, Anesthesiology, Perioperative & Pain Medicine at Stanford University School of Medicine; he directs the Pain/Stress Neurobiology Lab, the Jackson Vaughan Critical Care Research Fund, and serves as Editor for the journal Pediatric Research.