Friday, August 14, 2009

UBUNTU – a person is a person through other persons

First time in years, I wanted to be married sometimes last month. The last I felt the same way I must have been 5ish. A cousin was getting married and all the attention, the beautiful mekhela-sador (Assamese silk dresses) and the glittering jewellery she acquired, made me want marriage too.

Years have passed and I have not had to think about marriage since. (Except those moments when the boyfriends or the girlfriends wanted it and my bags were not already packed). But this time I wanted it. For a solid hour or so. Not for any romantic reason though.

Dad was unwell for couple of weeks and coping with extractive hospitals, unethical doctors and the general abysmal health care system in Guwahati made me want marriage. For the first time in my life I felt inadequate alone. The image of a gambhir (serious) yet, caring man, who is able to command respect and service from the lot of uneducated, diseased-in-the-head health care professionals(?) and at the same time provide sanity to my family came to my head. I wanted a husband like that. (Regular sex was a good thing too but let us not go there now). On my own, everything, from my small size to my singlehood, seemed like hindrance in getting assured medical treatment for my dad. Thankfully the marriage desire lasted only for that hour. But the bile bitter taste of the medical horror with private health care system in Guwahati remains.

To surgically cut the sick story short, it involved from doctor’s misconduct (reluctant and warped information + rude behaviour), overcharging, unnecessary procedures, bureaucratic inefficiency of hospitals and hospital staff to people’ jumping queue at the doctor. If it was my dad, he would give you blow by blow details of every interaction of the episode starting from the day he felt feverish and asked my mother to give him some hot water. But I am not so cruel. I am limiting the details to the professional health care system.

There was not a moment when the experience was pleasant and from what others shared with me in my time of dismay, it is not happening only to me. It is happening to a lot of people in India (and America I hear). I will not go into dissecting the health care system scientifically with data and case studies here. Yes I am concerned about the abysmal lack of infrastructure and professionals in the sector in India. These need to be addressed immediately to ensure basic health care to all, including the poorest person of the country and needs stern government intervention. What I want to talk about is the absolute absence of ethical practice and knowledge in the use of the existing infrastructure and by the existing ‘professionals’.

I will highlight a few rudimentary norms expected in an interaction between two human beings in a civilised set up that are completely missing in the health care system and sector:

Information Sharing: When two people talk to each other, the absolutely normal thing to do is to exchange information (in the form of emotions and eloquence). Conversations, for any reason transactional or and creative, requires coherent exchange of information to carry on the conversation at least, if not for any bigger outcome. But when I was talking to the doctors (except for a couple), information was the sparsest thing between us. Emotions ran bitterer, fees ran higher, but information remained meagre.

Sarcasm apart, all over the world, countries where patients’ rights charters are there, accurate and intelligible information to the patient has been recognised as a right. I remember Israel as one country with an admirable piece of document. I do not know about Cuba. When a patient goes to a doctor or a hospital, the patient or his family should be told about condition of the patient, diagnosis, treatment required, expenses and care involved, time needed etc. It is a basic principle. But I have forever heard and experienced it this time that doctors and other medical staff do not want to share information. You have to ask repeated questions to indecipherably short answers. Doctor’s come and go in seconds from your room without saying anything but ‘howzit’ and ‘have you taken medicine’. When you ask more they get irritated and evasive. Of course the scene is different if the doctor is a known one.

(Here I should put in an apology: To all my doctor friends who are not like the doctors I am talking about, you are not like that. I and you know that. But there are some and unfortunately I do not have you guys around all the time)

(And also a thank you: To all of those friends and family especially the doctors who helped during the stress)

Accounts, billing, papers: From the beginning till end, no one ever told us anything about money. When you go to get admitted you pay certain amount as registration and sometimes as security deposit. From then on till they release you (willingly or unwillingly) they do not tell you anything about money. They do not tell you how much you will be paying for the doctors, for tests, for medicines or any other expenses. You do not know how many specialists will come and check you without your knowing and charge you for it. At the time of my father’s release (nearly had to force our way out of Hotel California), they told me an amount I had to pay. When I asked for the bill I was told, “You go make the payment, we will have the bill ready.” What?!?!? I could not believe my ears and the accountant’s logic. I am expected to pay without seeing my bill?

I also noticed how much money is charged as professional fees (apart from tests of course). There were 2 resident doctors and 2 specialists who checked on my father five times a day, charging for each visit. Yes, you want competent medical treatment and care but 5 times a day? Is not it a bit too much? I would understand if the patient is in critical condition. In which case there should be arrangement for such patients to be kept in special spaces with continuous medical attention. But at other times when doctor’s just walk into your room for 5 seconds, don’t even touch you (it is important in healing, it is good energy) and charge for that specialised attention, it’s a rip-off. Also bringing in specialists (supposed) without consulting the people who will pay for it, is it ethical? I don’t believe doctors should be charitable angels with nothing but devotion to free service as their ideal. But by allowing professionals to be inaccessibly expensive to some people are we not saying the people with no money have no right to such specialised health care? Isn’t health care directly connected to life? Hence isn’t not having right to health care is depriving people of their right to life?

Respect, Etiquette, Efficiency: How is a person who has come to avail a service I offer voluntarily and is paid for it, inferior or unwelcome to me? Why would I talk to a person who has come to my workplace for work rudely?

In the hospitals, I saw, receptionists, nurses, lab technicians, whole lot of other people who work in the hospitals including the doctors are generally at best standoffish and at worst pointedly rude to people. When you come across one who is normal (not sweet but with basic respect), it feels like an aberration. What does it take to make an interaction professional if not pleasant?

Also everything takes a lot of time, if you ask the nurses or the receptionists etc for something (for the patient, not for yourself), they have made it the norm not to respond immediately. At first they will have to pretend not to hear you, then to ignore you, then to ask you to go to someone else or tell someone else to do it themselves and then eventually somebody doing it or you getting pissed off. This is the regular procedure for getting drips changed, having bandages removed, getting temperature checked if there is a fever, getting the doctor’s number and getting the bill ready etc. Isn’t efficient delivery an ethic too?

Bureaucracy, Corruption and Nepotism: How many people does it take to get a paying cabin if you are willing to pay and there is a cabin available in a hospital? I do not know. I had to call my ex-cousin-in-law (imagine how strenuous a relationship), who is a doctor at the same hospital, to get a special instruction from him to get a cabin for my dad. When I asked, I was told there is no cabin available. But I saw people checking out and few cabins getting emptied. So I called ex-cousin-in-law and told him. Within 5 minutes, while I was still standing at the same spot, they told me there is a cabin unoccupied for you. This in a private hospital where I am paying for it! There were a few other incidents that needed string-pulling. But as I said, I won’t be as detailed as dad.

I have also heard of nexuses between insurance agents and doctors (the one who certifies) where they make extra bills, get the money from the insurance company, pay the hospital whatever is due and share the excess between them. Although I did not face this personally, the doctor who was handling insurance in one of the hospitals wanted to put dad into an ICU where as my dad was ill but in no serious condition. Dad refused to go to ICU because he hates air conditioning. But the doctor could not explain why he was insisting on ICU. When I pushed, he told me there was no regular bed available so they have to put him in ICU.

This story is going long I know… but I have just been through it for the first time as a responsible (?) adult and my anger is acute. I had to get this health care thing out of my oesophagus. Besides the thought of thought of marriage has been a trauma.

What I actually want to talk about (0h, no, another long story) is the absence of ethics… (Did I say that before?)…

I also want talk about ‘UBUNTU’:

I heard the word Ubuntu within the first few hours of my being in South Africa. While passing some papers in the orientation programme that welcomed us, someone said, “pass the rest of the papers to the next one before you start reading yours. Ubuntu. Think about the next person.”

I heard Ubuntu many times in many conversations there on. Even jokes about Ubuntu. I read while Googling for this writing, that Ubuntu is an African philosophy, its origin in Bantu language. Various similar sounding forms of the word are present in some other African countries and languages. Ubuntu is an ethics that guides social discipline through human generosity.

From what I gathered from Wikipedia, between Nelson Mandela and Desmond Tutu they elaborated Ubuntu as –

“A person with Ubuntu is open and available to others, affirming of others, does not feel threatened that others are able and good, for he or she has a proper self-assurance that comes from knowing that he or she belongs in a greater whole and is diminished when others are humiliated or diminished...”

“Ubuntu does not mean that people should not address themselves. The question therefore is: Are you going to do so in order to enable the community around you to be able to improve?”

Think about others, think about the next person. Of course you think about yourself too. - Is this not a simple practice that would make the whole world so much better? When the person next to you, the community you and the next person are part of is not happy will you be able to be happy? If one just tries and thinks about the next person while trying to jump queue, abuse power advantages, cheat people, if we think about what the next person’s experience going to be, would it not help? Would it not make us do things differently? And I believe if we took time from our ‘artificial materialistic’* preoccupations to practice Ubuntu even for 10 minutes a day to begin with (like yoga you know) a definite change will come.

I believe the lack of elementary decency in everyday interactions can be made redundant with Ubuntu. Things can be bearably polite. And for this we do not need to need charters, policies or acts. Having them in place helps the fight. But only adherence to certain ethics can bring in the change. Imbibing them effortlessly as culture would be the ideal. Official obligation would be an acceptable beginning. But lack of respect and consideration will be unacceptable.


Practising Ubuntu will make the world perfect.

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*‘Artificial Materialism’, I think, is love for materials that is driven by forces beyond the utility and benefit the matter can render. To have material comfort, let’s say to sleep nicely, a firm, comfortable bed is enough for every person in the world. Rich or poor, under normal circumstances with normal ups and downs of life a person will be able to get a good night’s sleep from a bed that costs only Rs.2500. No micro-fiber filling and pressure-drop technology (just made it up) will be able to give you more sleep physically. Only contentment brings good sleep which we all know, no amount of money can buy. But many people buy beds that cost much more because it is supposed to beautify their bedrooms or increase their social standing. Sadly contentment does not come from beauty or sleep from standing.
This is ‘artificial materialism’- A need for materials that is artificially created by external forces like – capitalism??

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P.S. Eventually am I becoming like my dad? Am I preaching?