Since late 2009, the hospital has had one unique asset: a piece of equipment called a P.C.R., which can multiply tiny samples of DNA and analyze them. The device is not as fast as the GeneXpert, but it can examine the genetics of virtually any organism, including tuberculosis. The hospital’s machine, which was purchased with money from a government research grant, has never been used. “The hospital has had this for months,’’ Mannan said. “But nobody knows how it works.” We were standing at the door of the virology lab, where the new P.C.R. Cobas TaqMan 48, made by Roche and sold for roughly fifty thousand dollars, was resting on a shelf, still wrapped in its shipping material.
How could that be? I was staring at a machine that could alter, even save, the lives of scores of the people who were sitting nearby in the gathering heat. Mannan said nothing, though his anger was palpable. “Ask them,’’ he said, referring to the scientists who worked in the hospital, when I tried to get him to explain. “They will tell you.”
We walked down the hall to meet Ravindra Prasad, a doctor in the department of social medicine. He was an agreeable man with a round face and an easy manner. I asked why the P.C.R. machine sat imprisoned and unused.
“The chemical kit expired,’’ he said, smiling politely. The chemicals used in the machine have a short shelf life; but I learned later that they are not hard to replace. That couldn’t have been the reason. “The methods we have for diagnosing tuberculosis all function smoothly,” Prasad added, as if he were reading from a prepared statement. He was referring to sputum tests, which are often inaccurate. “We follow the standard manual.” Prasad offered us tea, but said nothing more about the medical needs of his patients. “It’s a nice lab,’’ Mannan said when we left. “Beautiful, actually. But if the doctors used it properly that would interfere with their private practice.”
I asked what he meant.
“It is simple,’’ he said. “If patients are treated at the hospital, they won’t need to pay for anything else.”
The Darbhanga medical red-light district lies just a few blocks from the main hospital. On most days, as the public clinics prepare to take their last patients, touts appear in the waiting rooms and on the hospital grounds, eager to steer people toward a private doctor on Hospital Road. More than eighty per cent of medical services in India are in private hands, and health-care costs are among the most common reasons for bankruptcy.
The touts—equal parts salesmen, psychologists, and pimps—are good at their job. If you need TB medication or a test or an X-ray, these men will get you quickly to a clinic that charges for services people are entitled to receive at no cost in public hospitals. According to Mannan, the tout receives ten per cent of any eventual fee from a referral. Rickshaw drivers get five per cent, medical assistants ten, and the referring doctor, almost always a physician based at the Medical College Hospital, thirty-five per cent. That leaves forty per cent for the clinician.
Much of the time, the referring physician from the public hospital is also the private clinician who does the work. That earns him seventy-five per cent of any fee. Public salaries are not sufficient to support most doctors, so, every afternoon, many of the hospital’s physicians work in these private clinics.
Well-trained doctors are not the only people working on Hospital Road, however. Officially, a doctor needs a license to practice medicine in India. In fact, though, there are no mechanisms to verify the validity of licenses or to punish people who break the law. It is not rare for “doctors” to lack medical training completely.
We arrived as darkness began to fall; hundreds of people, having finished the workday, crowded the rutted streets. There were dozens of drug shops, with names like Raj Medical Agency, Krishna Scientific and Surgical Works, and Zar Whole Sale Drugs—often illuminated by a single bulb. The streets of the medical red-light district are filled with “specialists.” Mannan and I wandered into a back alley where two men asked after our health with more solicitousness than was necessary. I asked what they were offering, and one of them let out a loud cackle.
“Let me show you,’’ he said, and led us to a small room with several chairs, a table, and three refrigerators. The man said that his name was Pranay, and he offered a variety of blood tests, for liver function, kidney function, H.I.V., and several other standard diagnostics, all at reasonable prices. Wholesalers make their money through volume sales, not high prices. “We get twenty-five to thirty referrals a day,’’ he told me.
The stall next door could have been an exhibit in a science museum: it contained an ancient X-ray machine, held together with duct tape and baling wire. The owner had just finished taking chest slides for a middle-aged man. He didn’t offer any of the customary lead shields or other protections against possible radiation leaks—and that machine certainly leaked. “It’s safe,’’ the man said. “They are X-rays.”
He told us that he ran about fifteen to twenty chest X-rays a day; he charges a hundred rupees for each, or a little more than two dollars. His services were also available for broken bones and other routine problems. I asked how he had acquired his equipment and where he had learned to use it. He told us that he had taken the X-ray machine from a hospital in Bihar that was about to throw it away. The idea of training made him laugh. “Did you see ‘Slumdog Millionaire’?” he said. “Before this, I was a chai wallah’’—a man who serves tea—“just like that kid.”
It was time to return to Patna; driving late at night on the roads of rural India is a risky business. Before we left, though, Mannan insisted that we make one more stop, at another clinic nearby. The place was essentially an open concrete garage; against one wall stood a small table with hot plates on which patients could heat rice. The room was full, and more than a dozen people stood on the street, waiting to get in. “This is the best TB clinic in town,’’ a pharmacist who owned the shop next door explained.
The head of the clinic, Dr. P. M. Srivastav, works at Medical College Hospital, and we had spoken with him earlier. At night, for a hundred and thirty rupees, Srivastav will see anyone who waits in line. He doesn’t test for tuberculosis at his clinic, and said that he refers people he suspects of having the disease to the hospital. He does, however, earn a fee from every patient he sees, including those he sends back to the hospital for free treatment. “Now do you understand why that machine is wrapped in plastic?” Mannan asked.
As we were about to leave, a large car pulled up at the front door. Srivastav climbed out of the back seat, looked at us with surprise, and smiled sheepishly. Before I had a chance to ask a question, he was gone, safely tucked away in his private office.
Read more
http://www.newyorker.com/reporting/2...#ixzz151oaHUYR
Dystopian Nightmare of Nationalized Healthcare
Reply With Quote
Originally Posted by Hazir
Honestly, I was pretty ill and the doctors didn't know what was wrong. My parents had already taken me home.
