PRIVATE MEDICINE DELIVERS IN INDIA

What a piece of work is India! I have just returned from Mumbai, reeling from the collision of first with third worlds. I had rushed to Santa Cruz, a smart suburb of Mumbai, to be by my father's bedside at a hospital with the worryingly old-fashioned name of the Dr Dadubhai Saraswati Hospital. My father had suffered a heart attack and was undergoing tests to establish what needed to be done.

In times past, we would have flown him to some private hospital in London, where he would have had the latest technology at his disposal and we could confidently expect a moonlighting and highly qualified NHS cardiologist to carry out the operation. No more. India is awash with cardiologists and surgeons. The country that has stuffed every global corporation with IT experts and accountants is also producing medical specialists by the thousands. Mumbai has hospitals full of world-class surgeons, scalpels at the ready.

So, Dr Dadubhai Saraswati Hospital it is. Mongrel dogs and their puppies are in the hospital compound. The monsoon has ensured that everywhere is splattered with mud and dirt. And dozens and dozens of people crowd the entrance. I am shown the way to the intensive-care unit. Nothing could be more different from the scene I've left behind. The hum of air-conditioning heralds a spanking-clean waiting room. No mosquitoes, no flies, just quiet efficiency. There is a video screen in the corner that responds to touch commands. I type in my father's name. Up comes all sorts of information - the name of the doctor in charge, his room number, and not just the day and date of my father's admission but the precise time: 10.44.50. The people at the reception are courteous. They tell me that visiting hours are from 10 to 11 in the morning. As it is 9.45am, we should be able to see him shortly. All this, and no money has exchanged hands. Modern, secular, corruption-free India is here at last!

The next few days pass with a surprising orderliness. Guards closely manage the waiting room, ensuring that no more than two people are allowed in at any one time. Bags are checked - not for suspect terrorist equipment but to remove any food and drink from visitors. Indians, given half a chance, will bring out their home-made chapattis and tiffin boxes anywhere and at any time. But Dr Saraswati was wise to this and has banned such behaviour.

We meet many times with the surgeon. It would be hard to come across a more urbane, sophisticated man. He answers our questions with practised ease. More than that: he fills us with confidence. He is one of India's top surgeons and charges a pretty packet, but he is right up-to-date with the latest in surgical techniques. And he is planning to perform the operation using a new technique called "beating heart" surgery. It turns out (as we discover later that night surfing the internet) that this method does what it says on the tin: namely, keeps the heart beating while the operation is under way. It replaces the more conventional method in which the heart is stopped and blood diverted through a heart-and-lung bypass machine, then artificially pumped back around the body. Just two years ago, the BBC was reporting the trials of this technique at the Bristol Royal Infirmary. Now our man in Mumbai is going to use it on my father.

The surgeon's account of what he will do is so assured and stated with such conviction that we consent. The date for the operation is set. We all meet again three days prior to the operation. One of the surgeon's assistants informs us that he will need five pints of blood. Jolly interesting information, I think to myself. But I am missing the point. We are to provide the blood. I'm sorry? Yes. Apparently it's our job to provide fresh blood for the operation. Hospitals do have their own supplies but they are limited and could be stale. Suddenly, we are back to third-world reality. India does not have an effective blood donor system. The whole business takes me aback - but my sister immediately starts sending text messages to all her friends to find out (a) who is B+ and (b) whether they are ready to give a pint for her father. All sorts of people reply. The good news is that everyone seems to know his or her blood type. But some are recovering from an illness; others are away. One text simply says "me, me, me, me - please let it be me". By that night, three have agreed. In the morning, two more come forward. The blood is given and tea and biscuits handed out. Even better news comes the next day - all the blood is "good".

Come the day of the operation, we all head for the hospital. It's going to be a six-hour operation starting at 10am. We arrive by 9am with no thought other than to be around as the surgery progresses. We rest content in the knowledge that, here in the stiflingly damp heat of the monsoon, my father is in the hands of a surgeon as good as anyone in the world, carrying out an operation at the cutting edge of cardiac surgery. Within minutes of our arrival, a very typical Indian commotion disturbs the calm of the intensive-care unit waiting room. The word "platelet" is bandied about a lot. Apparently, the surgeon wants six platelets to be ready by 11.30. I do not have a clue what a platelet is. (Dictionary definition: "Platelets are one of the three types of blood cells, along with red and white blood cells. Platelets are small and sticky and their job is to prevent bruising and stop bleeding after an injury.")

The trouble turns out to be that Dr Dadubhai Saraswati Hospital doesn't have any platelets of its own. It might have the latest high-tech equipment in the operating theatre but its blood banks do not have "platelets". A nearby hospital - 30 minutes in Mumbai traffic - apparently does. Whose job, though, is it to collect them from the other hospital? No one seems to know the answer. But now somebody has to go. Once again, members of my family come to the rescue. Of course, we cannot just go and collect them. We need a form, signed in triplicate by an official of the hospital. It is now 9.45am. The operation is about to start. In the cubicle where the official sits, we are told to sit down and wait. The official is deep in discussion with someone else. My sister translates the conversation for me. They are talking about the merits of particular taxi services and making arrangements for the transportation of some patient in about two weeks' time. Any attempt at pushing this along is met with a stony glare and an implication that the taxi conversation could go on for a good deal longer if we don't do as we were told. The official merely shrugs when told that the surgeon has requested the platelets by 11.30am.

My brother goes back to the intensive-care unit to persuade someone to call the platelet official. The call is made and the official finally looks up at us, scribbles something down and instructs us to go to the next office. It takes her precisely 30 seconds. In the next room, two girls are painting their nails. Some slightly hysterical conversations later, we receive the forms. We need to copy them but, it transpires, Dr Dadubhai Saraswati Hospital does not possess a photocopying machine. One of my cousins, wise in the ways of Mumbai street traders, rushes out into the main road, finds a kiosk that makes photocopies and returns within minutes.

A frantic journey ensues through traffic-laden Mumbai streets. Mercifully, the hospital with the platelets delivers the precious blood cells with speed and efficiency. The car races back to deliver the platelets to the operating theatre. By the evening, the operation is over. It turns out my father needed a triple heart bypass. A little later, the surgeon comes to see us in a scene familiar to viewers of all medical soap operas. But it is good news. He is very happy with the way the operation has gone. Now, it's up to my father. The next 72 hours are critical. He is in the post-operative intensive-care unit. A video screen is set up for us and a camera placed in front of my father's bed. We can see him: knocked out and full of tubes coming out of every part of his body. But there he is. And within days he is able to speak to us through the video screen.

Today, my father is back at home, just ten days after his operation. I am back in England. Oh, one last thing. When it came to paying our suave and sophisticated surgeon his fee, how did he wish to be paid? Cash, of course. Some things will never change.

This article by Samir Shah first appeared in the "New Statesman" of November 15, 2004 under the title "A Bollywood hospital saga"




Florida: Judge blocks "bad doctor" amendment: "A judge Monday temporarily halted a new state constitutional amendment that would yank the licenses of doctors who commit three acts of medical malpractice, saying that some specifics need to be spelled out before it takes effect. Circuit Judge Janet E. Ferris agreed in part with hospitals that sued seeking to block the amendment from taking effect until some aspects of it can be clarified, most likely by the Legislature when it meets in the spring, or by the courts."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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