So many doctors but still no cure for India

Medics lured overseas are returning, but only to private hospitals - while the poor still suffer.

Asha Devi has been waiting at the All India Institute of Medical Sciences Hospital in New Delhi for two weeks for her eight-year-old son's heart bypass surgery.

NEW DELHI // In the waiting room of a private medical practice in an upmarket area of New Delhi, businessmen in suits sit next to housemaids clutching babies, while an occasional foreigner leafs through an old newspaper. It is rare to see such a motley crew in the same place. But then there is little about Dr Gita Prakash's medical practice that is usual. "The people I see are from all walks of life," said Dr Prakash, eyeing her waiting room for any straggling patients.

"We have so many people and the hospitals simply don't have enough space, especially the government hospitals." To counter the overcrowded and underfunded Indian medical sector, Dr Prakash, 54, has quietly been playing her own part for the past 25 years. While working at New Delhi's exclusive Max Hospital during the day, by night she runs a clinic in Defence Colony, a high-end neighbourhood in southern Delhi for expatriates and wealthier Indians.

"I like coming here because [Dr Prakash] pays attention to me," said Geeta Khes, a 25-year-old maid who has just had her second child. "I bring my baby here because we trust what she says. "There are too many people [in public hospitals] so they can't give care to everyone. It is much better in private hospitals but this is not affordable." Dr Prakash's prices reflect her ethos. Those who can afford her highest rate, still a fraction of what most private clinics ask, pay 200 rupees (Dh15), while their servants pay only 30 rupees.

"I run this clinic mainly for the poorer people around here," she said. "The servants, the cooks, the gardeners, the security guards. They can't afford to go anywhere else, which is why I'm doing my little bit. "Those who can't afford to get into a private hospital do have a raw deal." For several decades, India has been victim to the success of its own physicians and nurses. It is the largest provider of émigrés in the medical field worldwide, with the US, Britain, Canada, Australia and the Gulf employing nearly 100,000 Indian doctors to fulfil their own needs for qualified medical staff, more than 10 per cent of the country's medical talent. The drain has had the obvious effect: a 2006 report released by the Planning Commission highlighted just how grim the situation is. According to its findings, there is only one doctor for every 10,000 Indians, compared with the 548 doctors in the US and 249 in Australia. There is a shortage of 600,000 doctors and one million nurses, the Planning Commission recently announced.

Most doctors are attracted overseas by higher wages, better medical equipment, higher health standards and a better standard of living. But this is all changing. Tougher immigration laws in the European Union and the US, as well as declining job security and India's own economic boom have seen many Indian doctors head for home. With them, they are bringing knowledge, experience and standards of practice previously unattainable in the country.

"The qualification levels and budget levels are improving fast here in India and they have improved a lot," said Dr YK Gupta, the chief spokesman for the All India Institute of Medical Sciences (AIIMS), widely considered the county's best medical college and public hospital. "The trend that saw [Indian] doctors going to the US and UK for quality training has reversed. They are now coming back to work here."

But while talented Indian doctors may be returning home with a trove of modern know-how, they inevitably move straight into the private sector, leaving the public health system as badly off as ever. At the crowded waiting room facilities in the AIIMS public hospital in New Delhi, people can spend months sleeping on the floor waiting for vital surgery that may come too late. Asha Devi, a 32-year-old mother from Jammu, in the Himalayan state of Kashmir, is one face in the teeming block of lingering individuals. She has made the arduous journey to New Delhi by train to secure her son's vital heart surgery. "This is the best hospital in India," she said from the chipped plastic chair of the waiting room, where she spends her days and nights in wait.

"People come here because you cannot get [necessary health care] in smaller areas of India. "For me, I have been waiting only two weeks, but some people have been here for many months." Operations such as the one Ms Devi hopes her son will get are heavily subsidised by the government, but the process to get clearance, and then secure a date of operation are drawn out and weighted down by bureaucratic hoop-jumping. The process often takes months or, in some cases, years. While India's private health industry advances each year through an increasingly competitive service market, the public sector wallows in dated equipment, shabby facilities and depleted staff levels.

While there were no private hospitals in India only 25 years ago, today every major city has several. Catering to a wealthier Indian clientele, as well as the increasing number of foreign patients, these private hospitals are absorbing most of the newly returned Indian doctors. Apollo Hospital Group, Asia's largest health care provider and the world's third largest, could not be more different to AIIMS. The 43 hospitals under the Apollo title across India boast internationally trained doctors and newline equipment that public hospitals could never hope to afford.

In the modern, spacious foyer of the Apollo hospital in New Delhi, people too are waiting. Despite the comparatively high costs, the hospital is running at 110 per cent capacity. "I've got patients that are waiting to get in to have surgery, but we don't have the beds," said Dr Arun Prasad, senior consultant surgeon and academic co-ordinator. "We could have another Apollo hospital like this right next door and it would be full."

The wait, however, is a couple of days or a week at most, a lot shorter than at public hospitals. After spending close to 10 years at a prestigious British medical facility, Dr Prasad is one such Indian doctor who made the choice to return home, and in 1996 started work at the Apollo hospital in New Delhi. "I was quite happy either here or there," he said. "Now that you have infrastructure of equal standard [in India], then it tips the balance towards coming back. Being in the capital city, the living standards are also now comparable.

"Culturally, it is always more comfortable being in the place where you've grown up." But with private hospitals in major cities competing for medical staff and offering excellent salaries and benefits, the public system, especially in the rural areas is suffering. In the national capital, the strain on public hospitals is palpable; in rural areas, it goes unnoticed. Hundreds of millions of people rely on regional, non-urban hospitals where medical staff are few and available beds a rarity.

According to the latest World Health Organisation report, nearly 136,000 women die each year because of complications while giving birth and nearly 2.3 million children under age five die annually. Most of the deaths, the WHO says, can be prevented by simple health care measures. "What WHO is primarily concerned with is the poor and vulnerable, and there is still room there to improve this participation and the rights for these people [in India]," said Dr Ilsa Nelwan, regional adviser for health systems at WHO South Asia. India also needs to boost its spending on public health, she said. The current figure lies at just over five per cent, one-third of what the US spends.

* The National