It was one of my routine visits to a PHC in rural Karnataka where I facilitate the patient counseling sessions for people with diabetes and hypertension. This PHC is 45km from the district head quarters and covers about 18,000 people. It was a busy day and the medical officer was attending to the patients. I silently headed towards the counseling room; there were about five patients waiting for me. I started my counseling session and explained to the patients about their disease, the importance of regular treatment and lifestyle modification.
Among them was a patient, who was around 45 to 50 years old. He showed me a few prescription slips written by different doctors and from that I figured out that his blood glucose levels were quite high in the last few months. I decided to have an individual conversation with him. When I asked him why his blood glucose levels were not in control, he started narrating his story.
He belongs to the same village; his house is located around 1 km from the PHC. He runs a tea shop for his daily living; he has a small family for which he is the sole bread winner. He comes to the PHC for his regular checkup, but is prescribed medicines from the private pharmacy, which he cannot afford. He said apologetically that he is not able to take medications regularly and that is the reason for his fluctuating blood glucose levels. He is unable to spend money for his regular medicine expenses, so he used to consume medicines whenever he has money. He has completely stopped taking aspirin due to the high medicine cost (each medicine costs 7 rupees) in the last few weeks. When I reminded him that he needs to take care of his health first, his response was, “if I spend the money on the medicine, I would not be able to meet the household expenses, pay my children’s school fees, or celebrate any festival. And for me happiness of my family counts the most”.
After a few minutes of our conversation, he asked me if I could do something so that he can get the same medicine in the PHC at free of cost. I listened carefully and assured him that I will try to speak to the medical officer see if anything can be done. After I finished my conversation with him, I went to the medical officer had a discussion about that patient and also enquired why is he not getting benefited from the PHC. The medical officer told me that the PHC does not have the stock of that particular medicine which he requires; his sugar levels are constantly high and are not getting controlled by the PHC medicines so he was given an outside prescription.
It’s not justa story of one patient whom I came across; there are many more who are suffering in the same way. During my routine visits, I have come across many such patients who have discontinued medicines due to financial difficulties. For people with chronic conditions like diabetes it is all the more difficult, as they need to take lifelong medication. This raises a question in my mind, what is our health system doing to help these poor patients? We hear about many programmes and schemes targeting the poor, but how far these programmes have actually reached out to the poor? I don’t have a solution to offer either, but unless we address these issues, we will not have an answer to the increasing burden and mortality of chronic diseases.
Santosh M Sogal
Institute of Public Health