Doctor on Top

The more the doctors in india lose their sheen and their once revered status with increasing drops in ethics and rampant commercialization, the more the doctors want to assert in their own clumsy way that they are on top of the health care hierarchy. The move of the government to consider exploring the possibility of upgrading physiotherapy from a paramedical discipline to an independent system of medicine has piqued doctors that “lowly para medicals” should be treated as any where even near the medical professionals.

The caste system in the medical profession is as strongly entrenched as any other caste system in India and far more difficult to eradicate than any formal caste distinctions. This is the case even though in Europe, especially the UK from where we have borrowed most of our social norms, things have changed a great deal and doctors there no longer assume airs. But in India, doctors have continued to reign as deities treading rough shod over allied health professionals – be it nurses or others.

This kind of attitude has led to the further decline in the quality of health care in India. With little social status, nurses and other para medical professionals are migrating in droves to greener pasture. According to the Indian Nursing Council (INC), there were over 1.28 million registered and qualified nurses in India in 2002. Earlier, a sizeable number of them headed out to the countries in the Middle East, but now its Europe which has woken up to give them a red carpet welcome.

Nursing actually has a low status in India, where deep-rooted cultural and religious practices identify nurses’ labour as “dirty” and “polluted.” Although nurses’ economic independence empowers them individually, culturally prescribed, gendered, and class-based practices in India overshadow these women’s transformations. In contrast, in the US nurses gain autonomy, and consequently challenge gender and class norms both within the family and within society.

And yet of course, most of us would have had experience that demonstrates that doctors; they are any kind of gods at all, are fallen gods, having sold their souls and prescription pads to pharmaceutical companies who spend on an average Rs. 7000.00 per doctor with gifts ranging from television sets and refrigerators and going on to cruises and foreign tours as per the data compiled by the Voluntary Health Association of India. Also the resistance put up by the medical profession when the doctors were put under the ambit of the Consumer Protection Act by claiming that theirs was a “specialized” field which others could not understand or comprehend. Of course it is not my case that doctors are the only arrogant profession, but being one myself it does feel odd knowing that many of the so called demigods in the profession actually have clay feet in many skeletons in many cupboards.

The way to go would be to deglamorize the medical profession and demystify health care as health care activists like those from the Medico Friend Circle, a body which includes many doctors is trying to do. They have tried ton develop alternatives in the form of community health projects with efforts at demystifying medical technology, rational and low cost therapeutics, and training of non-literate village level workers to provide primary level health care. Some have pursued the path of what came to be known as “people’s participation”, which ranged from encouraging the community to contribute towards the services provided, to getting them to select village level workers. But then traversing the path less traveled has a cost to pay, as one such counter current doctor , Binayak Sen discovered. A doctor cum human rights activist, he marched to the drum of a different drummer and for his pains is now languishing in a Chattisgarh jail for more than a year while his other well heeled colleagues in the profession live life king size.

The Putrid Pilgrim Trail

A doctor who has just started some charitable work in the island of Rameshwaram among Sri Lankan refugees has an experience to share. Hailing from Chennai, she was used to the thought of abandoning the comforts of city life and get used to the exigencies of rural life. But the one thing that greeted her as she crossed over into Rmaeshwaram and that one thing which she was not prepared for was the over whelming stench of human excreta hovering all over the island.

Apart from the infrastructural issues of there not being any adequate sewage disposal on the island, she wondered aloud as to why a pilgrim centre of religious significance should be so dirty and why whether or not the official machinery did any thing or not, the basic piety of the people should have served as some kind of an incentive to keep the place clean. Going by the press reports, the problem in Rameshwaram has been noticed and action asked for at least a year ago when A. Sellamuthu, Secretary for Housing and Monitoring Officer for the district, had directed the Rameswaram Municipal authorities to take urgent steps clean the island town. He had also noted that that “Rameswaram was an important pilgrim centre, which was attracting thousands of pilgrims and tourists daily. Hence, it had to be kept neat and clean always”

The question is worth asking as to why filth and squalor are so routinely associated with places of pilgrimages –except for the cash rich ones like the temples at Tirupati and Vaishno Devi and a few others and may be the Dargah at Ajmer. As for the rest, be it the shrine of a pir or a typical teerth sthan, the gathering of crowds for journeys of piety and pilgrimages are almost synonymous with dirt, disorder and chaos instead of harmony, serenity and order.

Remember the kanwarias who crowd up the roads every couple of months. Emerging from every little town and village that India has it would seem, they run through the land like locusts ravaging a field. Small time charities spring up to feed and shelter these hockey stick wielding pilgrims. During the time the season is on, these resting places are filled with leaf plates with flies buzzing, plastic and other waste lying around every where and ear splitting music of the crassest kind copied from the latest Bollywood hits but supposedly charmed to induce piety.

Or remember the Kumbh Melas, the largest gathering of humans on earth for any purpose, but not necessarily the most tranquil or peaceful. There are these akharas filled with opium soaked sadhus and their equally fanatic followers jostling for space and dominance. And oh yes, till modern times, the end of Kumbh Mela often sprouted cholera. The rather provocatively titled blog “ The Shit of the Saints is Still Reeking” talks pointedly of the 2007 mela in Allahabad and quotes the Chief Medical Officer of Allahabad alluding to the threat of diarrheal diseases, typhoid, and hepatitis as a direct result of the trash and human waste.

The Incredible India Campaign has run several direct ads on the need to keep and preserve our heritage –from vandalism as well as other acts that might desecrate them in any way. But they have largely concentrated and talked about historical monuments. But considering that so much of our heritage is tied up with religion and religious places and yatras and pilgrimages, it might do well to also talk of keeping religious places and events clean and sanitized so that the memory of having visited them might remain pleasant memories and not stories of nightmares.