Dear Mr Aamir Khan, I wanted to ask you if you have heard of John F Kennedy and what he once said – “Ask not what your country can do for you, ask what you can do for your country.” I direct you to this statement in view of the episode of Satyamev Jayate on Healthcare in our country.
Your programme shone light on a lot of important issues but unfortunately it is rather one sided and out of context. I was shocked to see that your show which is aired live and influences millions in India is so biased. I am an intern in a Private college in Karnataka and after going through the course and experiencing it I have an amateur understanding of the healthcare system of India.
The first thing I realised about patients in India, especially poor patients is that, they are still reluctant to come to doctors. Like you mention examples in your show, there are infinite examples of patients in India who consult doctors very late. Unaware of their condition, illiterate and backward they come to medical institutions when their condition has progressed beyond help.
So your show inadvertently has increased doubt in the minds of the poor regarding doctors. This is obviously not necessary in a country like India.
Your show spoke a lot regarding generic and branded drugs and the difference in the prices. It is true that the difference between the prices is shocking and unbelievable but a fact that was neglected and not even mentioned in your programme was how much is being done for the poor. There are 22370 Primary Health Centres as of a 2007 survey in India. They cater to the poor for free. All drugs, consultations and investigations and procedures performed there are free.
Tuberculosis kills two people every three minutes and India holds rank 1 in its incidence in the world. Tuberculosis kills over 0.37 million people in India each year. The treatment for the disease is long and dogged. It lasts for 6-8 months and involves drugs that are by no means cheap. All the drugs for Tb are free in India under a phenomenal programme called DOTS. Since the people of India are incapable of taking drugs regularly the government paid for special blister packs with different drugs for each day in one blister. That is imagine having one tablet of Crocin, one of Cetrizine and one of Phenylephrine in one strip.
The cost of drugs for TB per day for 6-8 months is Rs200 per day atleast .Do the math and you will see the amount being spent and the people being saved by the healthcare association. TB is just one example. The drugs for the most common diseases in India are free. Malaria, Diarrhoea, Leprosy, Cholera, Filaria, Kala Azar – All Free. India is the largest provider of Anti-Retroviral Therapy drugs to middle and low income countries in the world.
Now everyone in the world loves to talk and blame and criticize other professions, the difference is that when we do this, it influences no one. It’s other people’s dirty laundry being washed in the privacy of our home. When you do it, it influences millions. It pushes people to make decisions based on your opinion. Your sensationalising tone and melodramatic presentation of a few examples in a way that can only be compared to 80s Hindi movie has definitely made your TRPs shoot up but has shot down your claim of being a social activist.
A social activist comments on the good and the bad of a situation appealing for the good to prevail. Not once in your show did you mention that India has abolished polio and is now off the WHO list of countries in which polio is endemic. This is a task of monumental proportion in India, a country with a population of around 2 billion. All vaccinations, for all children are free in India, and as you know we have a fast reproductive rate, reminding you once again of the money being spent.
It is true that only 1.4% of the GDP goes towards healthcare but not once did you mention what is being done with that amount. The healthcare community does get only a meagre slice of the budget but no one can say that this meagre slice is not squeezed to its maximum potential.
On your show you parade the fact that the cost of an Undergraduate degree in medicine costs 50-60 lakhs. I would like you to know that my Undergraduate MBBS degree cost me a sum total of Rs 45,200 per year. Before you jump out of your seat and claim I studied in a Government college, I would like to remind you that I studied in a Private college in Karnataka (Refer Top of the Article). Being a domicile of Karnataka you may still say I had an advantage but my classmates from other states came via the COMED-K exam and paid a sum total of Rs3.25 lakhs per year. These are all merit seats. Nowhere close to your figure of 60 lakhs. Now if a student wants a seat which he/she has not achieved by merit, it is obviously a donation seat, one which can cost them 60 lakhs. But for all merit students within or from outside the state I can safely say that their UG degree could not have cost them more than a total of 25 lakhs for 5 years, that is to say around a tenth of the sum you are paid for every episode of this show. About the non- meritorious students who procure seats by payment, I decline to comment here. I suggest you have a separate episode for that.
Revoke licenses, now that is just a laughable point. I mean, we in India have a doctor to patient ratio of 1 doctor for 2000 patients and a density of one medical college per 38.41 lakh population. England on the other hand, where you quoted figures from has 1 doctor for every 440 patients or so. The difference is obvious. As a country we just cannot afford to get rid of doctors in the callous way you are suggesting.
For example, let us say Dr X is accepting a payment for prescribing a particular brand of drug to the patient, an illegal act, if we remove Dr X from his place and revoke his license no one will take his place. The badly treated patients will now be UNTREATED patients. Revoking licenses rampantly is not a solution.
Your show mentioned about a village in Andhra Pradesh where all the women had undergone a hysterectomy (removal of the uterus). On your show you proved your point conclusively that the operations were unnecessary. Some facts that you should probably know are listed below –
a) The doctor on your show mentioned that EXCLUDING cancer he had performed a hysterectomy very rarely. Fibroids, Endometrial carcinoma, cervical cancer, ovarian cancer can all be indications for a hysterectomy. 130,000 new cases of cervical cancer are reported every year in India alone. The death toll of just cervical cancer is 70,000 per year in India. It accounts for 15% of cancers in all females.
b) Let us even assume that cancers are off the table. In rural areas with deliveries and abortions performed at home in unsterile conditions, women are more prone to uterine rupture, Tuberculosis, Pelvic Inflammatory Disease and other disorders warranting a hysterectomy.
c) As a direct consequence of home deliveries women in India are more prone to genital prolapse, the treatment of choice in woman who has completed her family in such a case is HYSTERECTOMY
With all due respect in my year of postings in Obstetrics, 8 months as an Undergrad and 2 months as an Intern I have seen approximately 50 hysterectomies. I’m not saying that all the surgeries performed in the area you mentioned were necessary. I am only saying that chances are that a number of them were necessary and life saving. Blanketing all of them as wrongly performed surgeries without a medical history is not only immoral but also unexpected of a show called ‘Satyamev Jayate’.
In your pilot episode you mentioned that the purpose of your show was not to blame anyone, and was just to talk about these issues. In a country where illiteracy is rampant and your show reaches out to literate and illiterate alike, creating a public fervour and causing doubt in the minds of patients will lead to more harm than good. You stated that examples abound of doctors ill-treating patients but in our country there are more examples of people not approaching doctors, going to quacks and more. These examples are not in the people who come on your show, but in the villages of India and India as you know is a land of Villages.
The problems you state are true and of concern but more pressing is the need to ensure everyone chooses to get healthcare while striving to maintain better standards of healthcare. The solution is not to say healthcare is itself a dangerous option.
The effect of your show was highlighted in my mind when my mother called to tell me how great your show was and how careful she was going to be in going to the doctor. If your show has this effect on the educated, one can barely imagine the view the exaggerating audiences of India will take. On your show you mention as a joke that after it airs, you would hesitate to go to a doctor in India, but the fact remains that if you or your family members fall sick you will go to your family doctor (National or International) for treatment. The people of India on the other hand will hesitate to go to the one doctor available to them because of your show.
Satyamev Jayate originates from the first line of a verse in the Mundaka Upanishad, the whole line reads as –“Truth alone triumphs, Not Falsehood”.
I urge you to live up to the origin of the name of your show and highlight issues while considering the Big Picture and the larger implications of your programme and not just on the controversy and the love the audience in India has for controversy.
By Vivek
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