FALLING THROUGH THE CRACKS OF A FRAGMENTED HEALTHCARE SYSTEM - The Daily Guardian
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FALLING THROUGH THE CRACKS OF A FRAGMENTED HEALTHCARE SYSTEM

The healthcare system in India, in its current state, fails to view patients as people and link medical problems with larger socio-economic issues. Moreover, the commodification of public healthcare is reducing the bond between doctors and patients into a provider-customer equation.

Suravi Sharma Kumar

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The insufficient access to basic healthcare, combined with increasing life expectancy and chronic disease prevalence in the country, underscores the need for long-term comprehensive healthcare. At the heart of the issue of the sub-par performance of Indian healthcare, in comparison to countries with an equally mature economy and democracy, is this critical yet underappreciated problem of an unbalanced and broken healthcare system.

Though Ayushman Bharat and initiatives like the National Medical Commission Act and National Digital Health Blueprint have created a foundation for health integration, the current issue of a fragmented system needs to be addressed through better profiling of patients and better organisation of healthcare delivery, besides creating a seamless, interoperable and integrated system as well as digital health landscape.

The various parts of the current healthcare delivery system focus and act in silos without adequately appreciating their inter-relations and positions in the larger picture. This leads to inequality as well as in-equitability of healthcare delivery and the ineffectiveness of our increasing efforts to nurture improvement.

Sir William Osler, world-renowned physician and author, says, “It is more important to know what sort of person has a disease than to know what sort of disease a person has.” The experience of healthcare in our country, however, is too often one of not being known as a person. This experience affects the poor the most, who have difficulty getting access to basic medical care until their problems become emergencies. But it also is experienced by the rich and people from the middle class, who receive levels of healthcare as and when they need it, but feel abandoned when they want to put together the pieces of their illness-shattered lives into a meaningful whole.

A working mother of two from a middle class family went from doctor to doctor to try to find a reason for her fatigue and decreasing energy levels. Each doctor looked in depth at the organ/body system in which s/he had specialised in. Each did the required examinations and tests. Each prescribed the latest drugs. But the patient got worse with each passing day. She bought the best of each commodity available but, in the end, her problem remained and she only felt worse and depressed.

The above experience is the exact opposite of healing. Healing requires relationships—relationships which build up trust and hope, and a sense of being known to the healer/care provider, thereby, feeling a sense of security that s/he will get the best treatment. The emotional connection between the healer and the sick is unique—actually priceless—and imparts health benefits to the sick.

The current healthcare system in our country doesn’t contemplate on this aspect of care delivery. It doesn’t deliver empathy, hearing patients’ issues and building doctor-patient relationships. On the other hand, it has been increasingly delivering care/commodities which can be quantified, incentivised, and be sold or bought while the person as a whole—the whole system, whole communities—get worse, in spite of investing time, effort and money.

Focused research is needed to understand the behaviour of discrete treatments for discrete diseases, but when it comes to healing a person, it is fostered by a different science, one that considers the behaviour of multiple interacting factors which advance the health of people. It is unfortunate if the health professional considers only the disease and not the person. And it is the poor policymaker who designs healthcare systems that deal only with discrete diseases and fails to create environments that support interaction between different parts of the system.

A cacophony of narrowly focused programmes and services may be a good strategy for expanding revenues for service in the private sector but definitely not a strategy for efficient public healthcare delivery. Efficient healthcare requires an ability to personalise and prioritize problems based on “an acquaintance with the particulars”, seen in the context of a person as a whole or people as communities and systems.

Today, the efforts of public health, healthcare systems and philanthropists are directed at narrow programmes with insufficient focus on the larger picture. The lack of an integrative way of making sense of the world and the need to control and understand narrowly replace the greater promise of whole-system approaches.

Doctors treat whoever comes through the door, often oblivious to the many barriers to entry. Manufacturers make their products based on economic niches rather than public good. Hospitals and healthcare systems strive to attract “the right case mix” to maximise profits or just to stay in business.

Knowledge generation is partitioned in disease-specific institutes/initiatives without adequate balancing research connecting the dots beyond these boundaries. Specialists, drug and device makers, hospitals and service agencies focus on services without considering their effect on the whole person or system, or the opportunity costs on the social determinants of health (such as education and employment). The promise of healthcare is reduced when it is treated as a commodity—when patients become customers, citizens become consumers, and healers become providers.

By focusing their role on a technical skill, procedure, or body part, healthcare professionals attend to their responsibility limited to their areas of expertise without attending to the whole person and to society. In a healthcare system, we definitely can’t settle for technicians in place of compassionate healers. We have to remember that higher levels of healing are possible by balancing the biotechnical with the biographical.

Patients understandably are more dissatisfied with care delivery in a fragmented system. Indeed, the failure of repeated fragmented attempts to fix the problems can result in hopelessness. When we see only parts, disconnected from the whole, we lose our ability to connect to larger evolutionary improvement. The search for single sustainable solutions gets in the way of fostering development toward equitable, integrated, personalised, prioritised healthcare.

With a rapid growth in chronic lifestyle-related diseases and aging populations and their complex needs, there’s a pressing need for a comprehensive healthcare delivery system in our country. In an effort to cope with this growth, public health spending has been on a rise since 2014, with an increasing share of the country’s GDP being distributed towards public healthcare. An estimated sum of Rs 1.6 trillion was spent on public healthcare in the year 2018. But we must remember that in a fragmented healthcare system, spending more on the parts does not improve the whole system. Fragmentation at times turns well-intentioned actions into the unintended consequences like commoditisation of healthcare. Similar criticisms of fragmented disease-by-disease efforts by the World Health Organization have been raised on the 30th anniversary of the Alma Ata plan for comprehensive, universal and affordable health for all.

The benefits of integrated care have been widely acknowledged and it has been adopted extensively in North America and Europe, especially for the management of patients with chronic diseases. Understanding the fundamental problem of fragmentation in our disintegrating healthcare system would be an important step forward towards universal health coverage. Viewing healthcare as an evolving ‘whole’ (instead of as fragments/parts) can help us instil hope, where now there is cynicism, detachment and isolation, professional and corporate shared responsibility, where now there is narrow self-interest, and high-value healthcare, where now there is ineffectiveness, waste and inequality as well as inequity.

The writer is a medical doctor (pathologist) and holds an MA in creative writing from the University of London.

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I BROUGHT THE WHOLE CONCEPT OF FITNESS CULTURE: DR MICKEY MEHTA

In an exclusive interview with NewsX India A-List, Dr Mickey Mehta spoke about his journey as a health guru, fitness culture, life coaching, and much more.

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Dr Mickey Mehta, Author & Health Guru, recently joined NewsX for a candid chat as part of NewsX India A-List. In the exclusive interview, the author spoke about his journey as a health guru, fitness culture, life coaching and much more.

Speaking about his journey till now, he said “Many years back, I would say, when I actually started in the industry, as a career, that was the year 1980, so 1980-81. That was the time that coaches and fitness trainers had no respect, and there was not any formal training or qualifications available. People would say, ‘Kya karega jake, kya uthayega?’. I would say people had very scant respect for fitness trainers and they were called bodybuilders. We were put in the category of pehlwan, pehawani. I brought the whole concept of this culture—fitness culture, wellness culture, physical culture, and culturing the body. While you culture the body, culturing of the mind comes along. It translates into culturing your emotions, your psychology, and your spirit as well. So, anything to do with exercise, anything to do with training your body, shaping your body, culturing the body, translates into awareness because you become aware of more physical parts moving. You become aware of better by-product of circulation because if you circulate well, you don’t know how many liters of blood you have pumped inside because there is a feel-good factor.”

“It is about awareness that you have heart and you have lungs. Your heart beats for good things, for creativity, for sympathy, compassion and glow. When you do a lot of exercises, vanity comes to form because there is a glow because you are circulating. There is oxygen, so radiance, vibrance, so these are the by-products of fitness and physical culture. Mindlessness is not a negative connotation here. Mindlessness is when your mind is not you are and when the mind is, you are not, so you as a spirit are absent in the presence of mind and when you as a spirit are completely present in duality, the mind is absent. Mind is a negative phenomenon because the mind only lives and comes alive, either in the past or in the future. The mind is always wandering in the past. So, fears of the past keep haunting you, the anxiety of the future keeps you occupied,” he added

When asked about the plethora of people he has trained in the past and his experience of the same, he responded, “I think I had a short time of month and a half with Aamir Khan. While he was shooting for ‘Talaash’ and was also preparing for ‘Dhoom 3’. That short span with him was very interesting. My training with Lara Dutta also was very interesting. My training with Yukta Mukhi was very meaningful. With Priyanka Chopra, she was only 15 when I touched her, so not have memories with her but I am extremely proud of who she is today. They are the people who are very desiring and these are the people who are sincere as well. They were very disciplined. I remember Aamir used to call me at 3 AM in the night. The very first day, it was a 5:35 reporting and I thought that I would go there and he would then wake up. To my surprise, he was already up and about. These are very focused people, which is why they are successful, which is why they are leaders.”

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Mental health is not just about anxiety and stress: Divija Bhasin, mental health therapist

Mental & Emotional Health Therapist Divija Bhasin opened up to NewsX Influencer A-List about being a therapist in the digital age and responsibilities that come with being an influencer.

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Divija Bhasin, Mental & Emotional Health Therapist, recently joined NewsX for a candid chat as part of its special series NewsX Influencer A-List. In the exclusive interview, Divija opened up about being a mental and emotional health therapist in the digital age.

Talking about the kind of content she puts out on the Internet, Divija shared, “I make all kinds of things. I don’t just put out psychology or mental health stuff. I put that stuff along with other random or relatable funny stuff, even things that are indirectly related to mental health. Mental health is not just anxiety and stress, it is way more than that. It is also about our family systems and our education and even abuse. I try to make it a little simpler, relatable, and put it out there based on trends. It is like entertainment and education together. “

When asked did therapy come into her life first or being an influencer come first, she responded, “I have always wanted to be a therapist. I have been studying psychology since class 11th. I started out on TikTok last year. I used to make random videos on TikTok, sometimes psychology-related videos. I was just doing it for fun because of the lockdown but then I started gaining a lot of followers. I was like I like it and I am not that bad at it. After it got banned, I switched to Instagram and that’s when I started putting out more serious stuff. I realised that the audience on Instagram likes that and they also appreciate it more. I tried it on TikTok but it didn’t work out that well. Here, my audience likes both. That’s why I put both. I became a therapist after I started making videos not because I wasn’t going to be but because I am still doing my second master’s. While making these videos, I started working with another clinical psychologist. Under her guidance, I took sessions and now since I have some experience, I do private practice.”

When prodded further if these two worlds collide, she added, “Not particularly. It feels like my audience and clients are able to differentiate. They don’t try to talk to me and I make my boundaries clear. In the first session, I send them a formal email, stating that I will not be able to interact with you outside the session, just to maintain boundaries. They all respect that. I haven’t had experiences where my clients would try to become friends with me or something like that on social media. They follow me and like my videos but that’s it.”

Speaking about responsibilities that come with being an influencer, considering the fact that with being a mental health professional, the responsibility is twofold, Divija expressed, “I do have to be extra careful compared to other influencers because I feel like people are looking up to me to give the right information. Every time I put out anything serious, I make sure to read a lot about it, including research papers, not just random things on the Internet, so that it is properly verified and also in case someone questions me and thinks that I am just giving my opinion.”

Mental health is not just anxiety and stress, it is way more than that. It is also about our family systems and our education and even abuse. I try to make it a little simpler, relatable, and put it out there based on trends. It is like entertainment and education together.

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HAPPY POTTER

NAMRATA KUMAR

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The colour green is deemed to be therapeutic and soothing to the eyes. A person with a green thumb is someone who looks after their plants with a passion. Researchers recommend consuming green vegetables and to spend time in green environments whenever one can.

Nurturing plants and even crooning to them is believed to accelerate their growth. It is an opportunity for budding singers to practice their vocal cords for audiences or lack thereof. Humour aside, spending time with our green friends is cheaper than therapy.

People addicted to wanderlust in the current Covid-19 scenario have limited turf to wander on. With the work-from-home culture, many want to create inspiring and cosy nooks to work in while the wanderlust seekers take it a notch up by setting up a tropical vibe at home.

One can go to town making different and imaginative arrangements with plants and pots. As a result of which India-made garden accessories are en vogue.

The pandemic has brought many close(r) to mother nature. The lessons mothers teach us the hard way!

Zoom into the Tier one cities, The Humans of Bombay, Delhi and Bangalore also have different motives in keeping plants in close proximity to them. These cities with Air Quality Indexes that make one cringe have people stressing over not having clean air.

There is a gamut of indoor plants that can diminish pollutants from the air. There is no limit to how creatively these things of joy can be placed. A few popular plants are Areca Palm, Snake Plant, Aloe Vera plant, Spider plant, and Money plant. Plants lend a feel-good vibe to an abode cutting down on toxins in the air rendering them the most cost-effective air purifiers.

Areca palms make aesthetic plants that need moist soil and some sunlight indoors.

Snake plants are the least demanding ones requiring water once a month.

Aloe Vera is a multi-utility plant. Not only does it alleviate the impurities in the air but the gel found inside the plant has therapeutic properties. It maintains its stature without a constant supply of H-2-O.

A home decor aficionado’s dream plant: the Money plant. This decorative plant is easy to look after with a few sprays of water once a week. It winds around the shape of what adjoins it (only if that happened with real money).

There is an array of made-in-India pots to choose from. They are made from myriad materials such as terracotta, brass, glazed ceramic and handmade crochet.

A playful homegrown brand, The Wishing Chair (inset) doles out some charming little hand-painted pots. These bump up the cuteness quotient of any corner. Glazed pot with floral and chevron motifs is their signature style.

For a formal look, plant takers can head over to Mora Taara for their gold-finish and textured planters. Whether you are placing your stack on your workstation or on the floor of a living room these gilded numbers add a luxe feel.

Elementary, a Jaipur brand has a variety of earthy pots. These are minimalist with their geometric lines and are available with subtle tones. They are great extensions to a contemporary style.

The June Shop, a quirky Kolkata-based shop has some game-changing planters too. Their hanging crochet planters are truly special. These babies are suitable for any space ranging from a cosy family room to a covered outdoor patio.

Whatever the time, it is always ripe to nurture what is natural. Plant some seeds of time to potter around. It is sure to do you good. Happy Pottering!

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I TRIED TO CREATE A CONVERSATION AROUND SEXUALITY: LEEZA MANGALDAS

In an exclusive conversation with NewsX Influencer A-List, Leeza Mangaldas opened up about the content she creates on Instagram, the kind of conversations she has been having on social media, and how she has been helping youngsters get relevant information about sex.

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Leeza Mangaldas, Sex Positive Content Creator recently joined NewsX for an insightful conversation as part of NewsX Influencer A-List. In the exclusive conversation, Leeza opened up about the content she creates on Instagram, the kind of conversations she has been having on social media and how she has been helping youngsters get relevant information about sex.

When asked about the content that she is creating on Instagram, Leeza said, “I tried to create a conversation around sexuality, sexual health, gender, the body, identity. My hope is that this can help normalise these conversations because sex remains so stigmatised for discussion. Most young people don’t receive information. It is a normal part of life. It’s something we deserve, that is, accurate judgement about sex. The fact that most people have a smartphone now, the internet allows us to access the stuff from the comfort of our homes and privacy from our headphones and phone. It’s really lensed. I also think that young people use social media so much, people don’t put their phones down. They take it even in the bathroom. So, if you want to connect to young people, social media seems like a great way to do it, but it’s so important to me to have the conversation. A typical attitude to sex education is like let’s teach people how not to have negative experiences. ‘Ok, so it’s very don’t do this, don’t do that, and kind of fear-based approach. If you have sex, you will get pregnant. If you have sex, you will get an STD. Oh, it’s really bad that if you have sex, you will be punished as if you have done something wrong or evil,’ This kind of messaging is there. Any official messaging intended is laced with judgement and punishment. All of this type of language, absence base, fear-based or even when it is well-meaning it’s like not to get an STD or not to get pregnant. Nobody is focusing on pleasure. Nobody knows how we can have the best experience, it’s just talking about how we cannot have a bad experience. I wanted that shift where we talk about sex and its normal, important and wonderful thing, rather than a scary bad thing.”

Talking about the topics she has been addressing via her videos, she said, “I try to also allow for audience questions to dictate the topics I choose. I got a lot of questions repeatedly around certain things and addressed them. I think many people have a lot of issues when it comes to body image. Like questions around penis size, questions around boobs size, questions around why is the skin of the vagina is darker than the rest of the body or lots of questions around first sexual experience. I have created a lot of content types trying to provide help with full information on what you should know before you have sex. Consent is a subject that is important to me, talking also about stuff like arousals, desires, and being in contact with your own body and pleasure and understanding that you can communicate better because I think communication is central to sexual experiences.”

Speaking about where she draws a line between helping younger people to get relevant information about sex and drawing a line with what is the legal age to have sex, she said, “The age of consent varies from country to country and changed over time and it’s a really tricky area without easy answers in terms of age of consent of what is legal to begin having sex. In India, it is 18 but there was a time when it was something around 12 here. Child marriage is a part of how things operated in your grandparents’ generations. In other countries, it’s 16 and in some countries, it’s still even younger than that. So, how old is appropriate or not appropriate 16, 17, 18, 20. This is a question that doesn’t have an easy answer and it’s not up to me to decide. I’m also a citizen abiding by the laws, so of course, I maintain the age of consent. In India, it is 18 but I think the information, the education is something that has to start earlier and have to start when the child is learning the first word or when he learns the body parts. For example, you are teaching him this is your eyes, your nose, you are teaching them the words to think and why is it that we never teach them the correct names of the vagina, instead we say some other name like shame shame. You’re getting it, in such an age, this is shameful. So, of course, you should be appropriate but not for a one-time conversation, which you have with a young person. These are opportunities to normalise education around sexuality, body, sexual health, all through childhood because it’s usually the age 6 or seven somebody will ask mom, where do babies come from how would I get here or if you are expecting another sibling like how would it get in your stomach? Are you going to tell them that a bird dropped it or you found it in the dustbin? Why lie to the child? After there are picture books that simplify an explanation or consumptions and pregnancy, seeing things. When your adult teaches a child to get on her first periods, don’t you think they owe an explanation?”

I try to also allow for audience questions to dictate the topics I choose. I got a lot of questions repeatedly around certain things and addressed them. I think many people have a lot of issues when it comes to body image.

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Huge social media following comes with a certain responsibility: Rasika Shekar

Singer and Flautist Rasika Shekar, in an exclusive conversation with NewsX Influencer A-List, speaks about her journey as a singer and a flautist, as well as the responsibility that comes with having a huge following on social media.

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Rasika Shekar, Singer and Flautist, recently joined NewsX for an exclusive conversation as part of NewsX Influencer A-List. In the candid chat, Rasika opened up about her journey as a singer and a flautist, as well as the responsibility that comes with having a huge following on social media. Read excerpts:

Speaking about her journey, Rasika shared, “My flute journey started when I was 13. I started learning Carnatic classical music, then I came down to India to study Hindustani music. I was born in Dubai, grew up in the US, so music brought me to India. I have been exploring a lot more genres when I’ve been living here. I have been lucky to work on some Bollywood films, working on a couple of background scores. I have also sung for a couple of movies, as a playback singer and it has been extremely exciting. I am very fortunate that I am able to do so.”

Revealing that one song that she liked the most and has stayed with her, Rasika said, “I would say, the second song called Hulla Re, from a movie called ‘2 States’. I loved doing that song because it is a very upbeat, fun song and I got to do it with Shankar ji and Siddharth Mahadevan. It was super fun. I also got to sing the part that was in Tamil, which is my mother tongue, so it was a brilliant experience.”

Talking about her huge following on social media and the responsibility that comes with it, she stated, “I feel very fortunate to have that because we are able to interact with people that are from so many different parts of the world, so many different parts of the country. Technology enables us to do that, which probably I never expected or anticipated to be able to. I think that comes with a certain responsibility, at least I like to see it that way because it pushes me to be able to learn more and make sure that I am putting out quality work and I love that part. At the same time, because I am connecting with a very different audience, I feel like it pushes my musical boundaries and ideas as well. It is a really nice give and takes kind of a scenario, so it is very encouraging and I love it.”

When asked what she considers as her main responsibility when you say that you feel responsible for the people that are looking up to you, she responded, “At the fundamental, I would say that for me, it is to put out the most honest music. That’s my first thing. If I look at something like promoting it, it would be a different thing. If the promotion happens as the side effect of what I do, that’s great. When I am putting out music, I make sure that it is the most honest music that I put out. Secondly, I am always making sure that I am continuously learning and evolving as a musician so that I can create something different. Every time I can create something that is of top quality, to the best of my ability and at the same time, I am able to interact and collaborate with different musicians so that we can bring people something new, something fresh. To top it all off, at the end of the day, if I can bring a smile to someone’s face through my music, I consider myself really blessed.”

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I WANT TO SEE MAXIMUM NUMBER OF INDIANS SELF-EMPLOYED: VEERANDER CHOWDARY

Digital marketer and an entrepreneur Veerander Chowdary spoke to NewsX India A-List about how the Covid-19 pandemic made him feel the need for educating people about self-employment so that they can ride the waves of such uncertain times with ease.

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Veerander Chowdary is a skilful digital marketer and an entrepreneur. But now, he has set on a mission to train people and make them self-dependent for employment. We hosted Veerander for our series, NewsX India A-List. Below are the excerpts from the interview:

Describing his journey, Veerander said, “When we come to our journey, it’s quite interesting. So I’ll tell you why we started this. Before the first lockdown, there were so many people who were working, but after the lockdown, 7.3 million jobs vanished and people were in a situation where they couldn’t even fulfil their basic needs. That’s where I recognised why I can train people on how to become self-employed.” This led Veerander to start his own training course ‘BBA Mastery’. Chowdary claims that the course has trained 5,500 people so far and 40% of his trainees have succeeded in building self-employment opportunities for themselves. The digital marketer also said, “I have seen many digital marketing institutes, across India, which charge to the range of ₹75k to ₹1L.” He further added, “People from various backgrounds are investing in them and coming out without any practical knowledge. So that’s where I recognised why there is no need to spend such amounts on digital marketing courses when one can get the knowledge, for free, on YouTube.”

We asked Veerander what he feels sets his brand apart from his competitors, to which he replied, “Online course completion rate is very less because people don’t show any interest in completing the course. My competitors are training people using pre-recorded classes, but I give my students live classes every Saturday.” Veerander told us that he has spent the last 68 Saturdays giving live classes to his students. Moreover, he said that his course comes with lifetime access and at a reasonable price of ₹5,000, which he says makes his course stand out from what his competitors have to offer.

Speaking about the challenges in this endeavour, Veerander said, “The biggest challenge that I’m facing is the low course completion percentage. Out of 100 people registered for my course, only 20-25 people complete it.” He said his focus right now is on improving the overall content and adding value to the course so that more trainees complete it.

Our next question to Veerander was about the achievements in his mentoring journey. “Till now, I have a community of 2,76,000 students who are currently enrolled in my individual courses, out of which, 5,500 students are the paid students,” said Veerander. He continued, “When it comes to how many people manage to become self-employed, as I said, 5,500 people are learning through the courses and 40% of them are successful entrepreneurs right now where they are earning a minimum of ₹1L per month.”

For our final question, we asked Veerendar about his plans for the future. “I want to see a maximum number of Indians self-employed. Recently, we started our own edtech startup called Self Employment. We have launched the Android and iOS versions, as well, to give more learning flexibility to our students,” was his answer. Veerander concluded the response by expressing his desire to train at least 1 lakh people and make them self-dependent for employment.

Before finishing the interview, Veerander shared a few words of wisdom for the youth of the country and said, “Think creatively. Whatever field you are in right now, you need to stand out and you need to be creative. If you are the same as everyone, you will not get any recognition.” He also appealed to the youngsters to be of value to the people around them.

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