By Dr. Jeroen de Man
From April to September 2013 I lived in India to mentor an action research project targeting primary health centers. The project originated from a partnership between the Institute of Tropical Medicine, Antwerp, and the Institute of Public Health, Bangalore. The study site of our project was Tumkur, a district of Karnataka.
When Indians ask a foreigner how it is to live in Tumkur, they usually want to hear his or her opinion about the food, the climate, the culture, … And overall, I have to say I was pretty happy about all these. Unfortunately, something happened I did not expect to happen to a healthy 29-year-old male researching health care in India. I had the opportunity to experience the Indian health services first hand, and count myself lucky I can still write an editorial about it, some months later.
What knocked me almost out? On August 26, 2013, I developed a very bad gastro-enteritis with diarrhea, high fever, signs of dehydration, and extreme weakness. This is a combination of symptoms that should be taken seriously said my friend, an Indian physician who advised me to go to a hospital. I decided to follow his advice and went to one of the well-established private hospitals in Tumkur. Since this hospital was rated among the better ones in India, I expected about the same quality of care as provided in a basic hospital in my own country, Belgium. This feeling of safety ended quickly when the physician in charge came to see me at the emergency department. He asked me a few questions (first in Hindi which I do not speak) and within less than two minutes he had decided I had to be hospitalized. No clinical examination had been done and when I asked the nurse to measure my temperature, she touched my underarm – a technique that does not seem very reliable to me – and confirmed that I had high fever. When I entered the general ward, things got worse. I developed a severe pain in my stomach and a nurse had to detach me from the intravenous fluids every 20 minutes to allow me to go to the bathroom. After having visited the bathroom a few times, the nurses were fed up with me and decided to put me on a diaper in front of the other 7 Indian patients who were lying in the same room. After an hour or two my diaper got saturated and started leaking. This resulted in a bed full of stool. I started to feel a little uncomfortable and asked the nurse to change my diaper. She told me that this was impossible at two o’clock in the morning since there was no housekeeper around and that I had to wait some time. I started feeling really uncomfortable and decided to pull off the blankets from my almost naked body. The nurses told me that this was disrespectful towards the other patients in the ward but they finally got the message and sent me to the bathroom with a new diaper. The next morning they brought me the bill which included several medicines that were never given to me. I protested but had to pay the bill. Luckily for me, the hospital reimbursed me the extra amount two days later. I decided to leave the hospital and the physician in charge gave me a prescription with antibiotics.
However, my misfortune wasn’t over yet. After having swallowed the tablets during the evening of the same day, I developed a life-threatening allergic reaction which is called “anaphylaxis” in medical jargon. During such a reaction, you develop a very quick and heavy swelling of your face and throat. And indeed, my face grew twice as big as usual, I was not able to speak anymore and breathing became very difficult. As an emergency physician I knew that this was a dangerous condition which requires an immediate injection of epinephrine (a medicine to decrease the swelling). Therefore, I returned as fast as possible to the same hospital. When I arrived, I managed to utter the word “anaphylaxis”. The physician confirmed my diagnosis – it was not difficult since it was a classic example – and I was expecting prompt administration of epinephrine. Strangely enough, instead of treating me, the physician went to see another patient. I was being monitored and I saw on the monitor that the oxygen level of my blood was slowly falling because of the difficulties with my respiration. Ten minutes after my arrival at the hospital, I still had not received the medicine I was hoping for and I was getting afraid. I gave a sign to my friends who understood that something had to be done, at least if they didn’t want me to end up in the mortality stats. Finally the nurse injected me an antihistaminic, a medicine that can be given for limited allergic reactions but which was certainly not the first choice in my case. Fortunately, I was among the lucky ones so I’m still able to reproduce this story.
Studies about quality of care in public hospitals in India report room for improvement (see for example, Rao et al, 2006 or Puri et al, 2012 ). Peer reviewed literature on private hospitals is scarce, but some stories from the grey literature suggest that my experience was not an isolated one (see for example here, here and here). Private hospitals seem to be highly heterogeneous in terms of quality and poorly regulated by the government (see here for example). To uniformly increase the quality in these facilities, more stewardship from the government seems warranted.
Meanwhile, I wish you all a happy New Year!
(Glad I’m still here!)