During my summer of the year 2015, I had the great opportunity to visit the Institute of Public Health in Bangalore and to explore the Indian health system during a few days. During the first half of my internship, I was confronted with the great complexity of the problems in the Indian sector.
To begin with, I noticed that the government sector was truly avoided by the Indian population for several reasons. Some of them include a very bad coordination and communication within the government sector and the different ministries of health. I was shocked when noticing that two different ministries had built two health institutions next to each other without knowing it: one community health center and one primary health center, both lacking medical paraphernalia. Instead of coordinating and optimizing their human and financial resources to build one hospital, the government sector proved to be unproductive and non-transparent with regards to its actions.
Another striking element of the Indian health sector is the lack of cooperation and unity between the private and public sector. In most countries like the Netherlands, public and private sector work hands in hands and stimulate one another to provide quality healthcare. Talking to an employee of the Institute of Public Health working on a project to reduce the burdens of non-communicable diseases like hypertension and diabetes, allowed me to have a better insight of the relationship between private and public sector. I was told for example that the private sector would deliberately tell their patients that generic medicine from the government sector were not efficient, or even threatening to their health, which makes it inevitably difficult to imagine any form of collaboration between these two sectors of healthcare. Another example of hostility to collaboration between different actors of healthcare in India is the fact that private doctors refuse to use records or tools from other organizations or health providers, simply denying any other form of help.
My internship in Bangalore also taught me that health, and the importance one associates to it varies a lot depending on where you are. In Europe, health has become one of the biggest priorities, and people strive for good health in their everyday lives, whether trying to do some physical activity, to buy food with the least bad cholesterol or to take medicine with the slightest headache or feeling of pain. Health represents an important pillar in the European everyday life. In India however, I noticed that health does not come as a priority, because people still struggle for social recognition and acceptance. Having a social card to receive rice therefore becomes more of a priority than having adequate healthcare. This makes it difficult to implement any form of reform in the health sector that would be widely accepted by the population.
After seeing the intricacy of the health sector in India, one can be pushed to believe that one of the solutions to improving health would be to privatize the entire health sector to eliminate the competition, inequality and misbalance between the two sectors, and to guarantee quality healthcare. However, another lesson I learned is that the government sector does have necessary and beneficial influence on the healthcare. The government sector is the one sector genuinely interested in public good, and which always strive to help the entire population.
Furthermore, the government sector is the only sector that will provide preventive health care, which plays a pivotal role in overall health. This is due to the fact that preventive care is not remunerative and does not provide remuneration, making it worthless for the private sector to invest in.
During the second part of my visit, I was lucky enough to be able to discover the Adivasi community from Southern India and to get familiarized with a quite unique form of development based on empowerment and sustainability. During my visit of Gudalur, I learned a few essential lessons. One of the main conclusions I was able to draw from my visit is that development of a certain population can only be successful if it is population-based. External actors may of course come to teach and stimulate a community to develop itself, but the reins must be taken by the community. This allows to develop a feeling of responsibility from the population, of loyalty and thus of sustainability. If a community works together to reach certain objectives, it will also be able to enjoy the fruits of its labor, thus further encouraging it to carry on with a certain behavior. Only the people themselves are capable of clearly assessing the problems and thus are the only ones capable of coming with the solutions to certain issues. External help usually has the tendency to colonialize people and to render them dependent instead of empowering them. One of the teachers of the school of Gudalur, Ram, very righteously told us “We don’t look at the building, we look at the people. Buildings are ways by which you colonialize people” when referring to the simple architecture of the Adivasi hospital of Gudalur. All in all, this internship really made me reflect on the real nature of development: what really is development? Is development really the form we so often give it: material possession and financial wealth? Looking at the Adivasi community, I have learned that a feeling of community, of belonging and cultural identity can contribute so much to development, and that even minorities can achieve great progress without losing their integrity.
Following this experience, I have taken home some life lessons and made myself some objectives. As of September, I have joined the international organization Universities Allied for Equal Medicines, and joined in the battle to promote equal access to medicine. I was able to see that health as we see it in Europe is true luxury in comparison with India and realized how unequally the intrinsic right to health is distributed in the world. Besides this, I have decided to get involved with the refugees of Maastricht and want to participate in their integration within our society. Dr. Deva wisely advised us to always think of the minorities everywhere around us. Even in Maastricht, the Netherlands, thousands of individuals are forced to live in denial of their own identity, hoping to stay unnoticed in order to integrate the community. I am hoping to change this.
Hanna Schenck from Maastricht University was an intern at Institute of Public Health, Bangalore, India.
Disclaimer: IPH blogs provide a platform for interns to share their reflections on different public health topics. The views expressed here are solely those of the authors and not necessarily represent the views of IPH.
