Are we really moving towards ‘Health for All’?

Equality and Health

Different classes of our society have different income levels and with the Gini Coefficient moving against the poorer classes, it is most urgent that specialized hospitals be set up to save lives and alleviate suffering’

By Sada Reddi

A few months back, a thirty-year-old man died of a heart problem after he had been diagnosed and treated for gastric pain in a Health Centre. Another 51-year-old civil servant died after she had been treated for weeks allegedly for ear infection. According to her close relatives, she died of a rare nerve disease that was not diagnosed in time and which, in its early stage, is curable.

A friend, who was found unconscious at home, was rushed to hospital, but had to wait for 10 days for an angioplasty; he was told that the machine at the hospital was not functioning. He would probably have had to wait for quite some time — for how long, we do not know — for a heart bypass surgery. But thankfully his assertiveness helped and that paved the way for his surgery to get done at the Cardiac Centre of the Trust Fund for Specialised Medical Care.

We come across similar stories about medical errors, negligence or lack of medical care in both the public and private health sectors, with the only difference that in the private sector one can be discreetly compensated for any medical error or otherwise, which is why grievances are rarely aired in public.

In a class society, there is a strong perception that all our citizens are not treated equally in a number of institutions. The health sector, whether public or private, is no exception. Although generally people do get the services – medicines and care/treatment – which are available in the public sector, one has to listen to public grievances regularly aired on the media or the personal experiences of friends and relatives to realize the general dissatisfaction with the service. The majority feel they have to put up with it because they cannot afford an alternative service or proceed for treatment abroad.

It is a fact that the quality of medical services may vary from place to place, depending on the locality, the type of management and personnel. In fact, in any health centre, dispensary or hospital department, the services can vary a lot. It is really a mixed bag. One can come across a doctor who will consult your medical file, talk to you and listen attentively to what you have to say before giving you his advice and writing the prescription.

In the same Health Centre, one could at other times meet another doctor, who is nicknamed by own fellow nurses as ‘Rapid Service’. S/he would not even lift her/his eyes to look at the patient standing or sitting before her/him; s/he would simply look at the laboratory results and prescribe the drugs. On the other hand, we can come across a private doctor who will prescribe the same drug for any symptom you mention and sleeping pills for three months, and worse, prescribe expensive branded versions of drugs when less expensive generic medications are available. He could always argue that the medicine he prescribes is useful and most appropriate for you. But when the patient realizes that the owner of the pharmacy is a close relative of the doctor, he is justified in thinking that this amounts to unethical behaviour.

The health system comprises people, from health professionals to employees down the lowest rung of the ladder, who put in a lot of hard work with competence and dedication. But things get wrong too often due to lack of resources, misdiagnosis, faulty equipment and medical errors. There is the great risk that such weaknesses be considered normal with the result that substandard would become normalized in several areas in the health sector.

The situation is not different from what we got in the 1970s. When Sir Seewoosagur Ramgoolam got Prof N.R.E Fendall of the Liverpool School of Tropical medicine to report to Sir Harold Walter on the health situation, this is what he found: “At those institutions which I visited, both large and small, patients were being seen at the rates varying from one minute 18 seconds to 3 minutes 20 seconds per new case; and to as little as one minute per reattendance… these times are well below what a physician or a patient requires for a minimally acceptable standard of care. It is not possible to register, take a history, examine, diagnose, prescribe, and counsel a patient adequately in such a brief time.”

However, in some professional quarters, the estimates of time taken with new cases made by prof Fendall were thought to be on the low side and this view was shared by Dr Dickson Mabon MP on the basis of his visit to SRR National Hospital. It was generally accepted that there was grossly insufficient time to give an acceptable standard of care, and this was aggravated by the fact that generally nothing was known of the medical history of those patients.

To improve the services and make them available to all, the Prime Minister came up with ‘the possibility of a scheme which would give access without payment to general practitioners of those seeking medical advice.

It was in that context that in 1972 Donald Chessworth had, in consultation with Professor Brian Abel Smith, Tony Lynes and Dr Michael Young, proposed a report the creation of a ‘National Health General Practitioner’ programme. He also advocated the setting up of health centres in the country, an idea which was taken up in the 1975-1980 five-year plan. Meanwhile Sir Seewoosagur Ramgoolam had taken the decision that government employment was to be offered to all returning practitioners. By 1975, there were about 370 medical practitioners in the country and this has been increasing steadily from 1971 when there were 223; the number of nurses too increased from 877 in 1971 to 1049 in 1975.

Today despite the fact there are about 850 doctors and 2700 nurses in the public sector, a network of health services and a number of specialized hospitals, the health sector is still lacking in some services and efficiency. Society is changing, people live longer and technology opens new possibilities for medical investigations and treatment. Our citizens suffer from a number of diseases which could have been better treated if they had been diagnosed earier.

The setting up of a number of hospitals – for women, old people, children and cancer as well as one for animals – as announced by Navin Ramgoolam on Labour Day is long overdue and will significantly help the poorer classes. In the 1990s it was a Labour Government that introduced free hemodialysis in Mauritius after a girl had died because she could not afford the treatment. Nowadays those who can afford can hop to India for specialized health services, but what about the rest of the population?

A friend who had his heart surgery done at the Trust Fund for Specialised Medical Care was told by a heart surgeon that he would require about Rs 500,000 to do a bypass for the three blocked arteries in a private clinic. Different classes of our society have different income levels and with the Gini Coefficient moving against the poorer classes, it is most urgent that specialized hospitals be set up to save lives and alleviate suffering. It is then that we can say we are moving towards ‘Health for All’.

* Published in print edition on 17 May 2019