Navigating Healthcare in India: A Story of Resilience and Optimism

Arunava Saha, MD

The high-pitched ringing of the ventilator pierced the night air, rising above the general cacophony of cries, shouts, and laughter—the usual amalgamation of sounds omnipresent in a medicine ward. It was admission day at the largest government hospital in a Tier-II city of India, catering to a population of eight million; and it was absolute pandemonium.

Being the second-most populated country in the world comes with its fair share of problems. Despite the recent economic boom, India continues to perform abysmally in the global health security index and the global hunger index. These statistics highlight the widespread disparity and longstanding healthcare accessibility gaps. Yet, with a meager 2.5% of GDP spent on healthcare, India has managed to develop and sustain one of the most unique healthcare models in the world, driven by the philosophy, "Leave no one behind”.

While the rich have access to the best resources, the poor are not entirely forsaken thanks to government-funded hospitals. These institutions, although similar to the U.S. healthcare system, operate on a drastically different scale. Whereas the U.S. spends about $8,500 per person annually on healthcare, India spends about $40[1]. Consequently, public-funded government hospitals, low-cost nursing homes, or missionary-funded private hospitals are the go-to places. Despite this grim picture, which generates an image of a dilapidated building with people scattered around crying for help, the truth is starkly different. With donations through various NGOs, and occasionally from the private sector, and relief from international organizations, government hospitals continue to provide a beacon of hope for millions.

Medical training in India is rigorous, strenuous, and often formidable. A resident is expected to be responsible for the day-to-day workings: seeing more than 60 patients in an average outpatient day along with managing 80-100 admitted patients in the ward. All this means residents have almost no time to eat or sleep, let alone go home for a shower. They practically live in the ward, catching a few hours of sleep in the doctors' room or sometimes even on a gurney. Nursing staff is minimal, with one nurse catering to a ward of 80-100 patients, so patients’ relatives often take on most of the responsibility, including providing food and medications, helping the patient walk and use the restroom, and in some cases, even manually bagging their intubated loved ones for hours until a ventilator can be arranged.

Sometimes patients get angry, some bring their loved ones at the critical moment and create an uproar when nothing can be done—occasionally even attacking junior doctors in the process. But, for most of the population, the physician still stands on a pedestal. Traveling to a hospital is like a pilgrimage, where they leave their homes and families behind and travel long distances with the belief that they will have someone to help in their plight. Despite the hardships, the beauty lies in the fact that if instructed to do something, they try their best to follow it. This is where the sense of satisfaction in practicing medicine comes from—knowing that patients are willing to listen to you as you try to make a difference.

Obviously, in such a scenario, the healthcare system also has several lacunae. We lag behind in preventive healthcare; easy access to over-thecounter medications and antibiotics without prescriptions leads to worsening antibiotic resistance; inadequate data integration, issues of privacy and confidentiality of health data, and insufficient data sharing mechanisms affect continuity of care. There is also a stark disparity when it comes to access to basic sanitation and healthcare in remote rural areas; lack of access to essential vaccines, and extremely poor public communications infrastructure.

It is often said that India lacks “social solidarity”—a sense that people should take care of each other—and this has resulted in a health system rife with inequities. On the contrary, you will notice a strong sense of cohesion, camaraderie, and accomplishment when you enter one of these hospitals. Rooted deep in our culture is a unified consensus to do our best with what we have and not complain. As stated in the Bhagavad Gita: Do not worry about the results; keep performing your karma with due diligence. One would be amazed to see this practiced all around, where every single person—from doctors and nurses; cleaning staff and attendants; to scientists and researchers—is just doing their best to stay afloat and somehow doing a great job in the process. The approval of the country’s first natively developed chimeric antigen receptor (CAR) T-cell therapy, priced at a fraction of the cost in the U.S., is a testament to the same.

So, when the ventilator rang out at 3 a.m., connected to an intubated young gentleman with organophosphorus poisoning who was drowning in his secretion, the wheels in my head started turning despite the commotion. I dropped the urinary catheter I was inserting, my colleague left her first meal of the day, and my senior ran back after just exiting the ward a few seconds earlier. In a few moments, we had suctioned him, given him another dose of atropine, and reintubated him. As his vitals stabilized and the ventilator returned to its rhythmic beeping, we sighed and went back to our tasks.

In those few seconds of respite, the phone rang. A young patient with leptospirosis, liver failure, and septic shock was making his way up to the medical floors due to a lack of ICU beds. We looked at each other, grimaced, and went back to work. This is not just my story—it is the story of every medical resident who has pursued residency training in India.

As an internal medicine resident who has completed further training in the U.S., I feel privileged to have experienced both healthcare systems at close quarters. The differences and similarities between the two are striking. While it may not make sense for India to take lessons from the U.S., given its own struggles to fashion an effective healthcare system; I believe we have a lot to learn from both its mistakes and its successes.

Arunava Saha, MDPulmonary and Critical Care FellowTulane University School of Medicine saha.arunava100@gmail.com