42 Taking a lion's share

The Lion and the Wild Mule: A lion and a wild mule went for hunts together. The mule will chase a prey and run it down and the lion would then come up and kill it. When it came to sharing the spoil, the lion divided it into three equal portions. He told the mule, "The first portion is for the king of beasts - that is for me. The second is my half of what remains. I expect you to offer me the third portion out of regard and respect. Otherwise, you will feel sorry for yourself."

56-year old Sadhasiva Sastry was a temple priest with a modest income. He had a long standing problem of high blood pressure that had resulted in kidney damage and chronic renal failure. He was stabilised on medicines and weekly dialysis. He asked for kidney transplantation to be done for him though he was told to be a high risk case in view of the diffuse blood vessel disease. His elder daughter who was unmarried and 26 years old, was found fit to donate a kidney.

When his relatives went to a nephrologist, he asked them, "Are you sure? Why should he have such a high risk transplantation?" "So that he can live for a few more years and marry off his two daughters," they replied. "But after the surgery he will have no money left to spend on their wedding. Moreover, who will offer to marry the young woman with a large surgical scar and only one kidney?"

However, Sastry went ahead with plans to spend all his savings on the surgery. His daughter was taken to the hospital to donate one of her kidneys. 124

Comments

The expected follow up scene in Sastry's case would have been: his death within a few months due to a complication like a heart attack or a stroke; the family left behind in a state of penury; the young woman from an orthodox background, unable to find a suitable and willing groom.

However, in this case, Sastry had a massive stroke two days before the scheduled transplantation and died. The family had some financial resources, the young woman escaped the knife and the stigma and the eldest son was employed in the temple. I felt that Providence had intervened at the right moment to save the family but some others disagreed.

Heads of families often grab a lion's share of family resources for health care, be it the family property, organs of the family members or their time. It takes an astute physician to counsel the members of a family to arrive at the best possible decision for the whole family and not just for the one expecting a lion's share.

Grabbing a lion's share of the health care and health care costs occurs in many other ways. Perhaps these are more important to activists than the individual case cited above.

For example, if you study any government hospital, 65-85% of its budget is spent on its employees leaving very little for the public it is supposed to serve. Compared to what is administered to the public, even the drugs made available for its staff is of special range and quality. The special beds and private wards are often reserved or allotted first to the staff. The paying public has to wait for long periods to get in. One has to be a VVIP or a close relative of the hospital staff to have access to quality health care; in other words, one has to join the lions to share the spoils.

Some health professionals in the government service initially build up their reputation by hard work and then turn into 'Lions'. They convert the government hospital beds to de facto private beds. They charge hefty fees for service and refuse to manage non-paying 'worthless cases'. During the 70's, there was a professor in Kerala who used to collect money even to release the body of a patient who died in his ward. Public shaming was done by some activists to expose him to the society.

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The recent release of the citizen's charter of health care rights is a belated step in the right direction (See Appendix). Health activists and consumer groups have to push hard to change the current self-serving paradigm of public health care to one that is citizenfriendly and citizen-oriented.

Grabbing a large piece of cake is also a part of private health care industry. Private laboratories and speciality care centres are forced to cough up as much as 60% of usercharges as kickback to those who refer cases. I know a radiologist in Kerala, who was so disgusted by the avarice of some specialists referring cases for a CT Scan that he quit his lucrative job in the private sector; he joined an ethical non-profit scan centre set up by a trust.

How to beard these lions in their own dens and curb their avarice is a question that needs serious thinking and followup action by planners, activists and regulatory bodies.

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