Central to it all is a titanic struggle between demand and supply for critical medicines, oxygen, ambulance services and even for sweet lime and coconut water with crafty middlemen making the most of it.
India, it is often said, is a land of contradictions and it has been reinforced by the unfolding Covid crisis. The rising caseload – currently at a worryingly high level of around 400,000 new cases each day – has laid bare a hugely benevolent side of Indians as well as an utterly ugly face. At one end, there are conscientious individuals donating personal wealth, gathering resources or giving up a hospital bed in favour of a younger person or a gurudwara offering oxygen langars (their famed community kitchen concept now repurposed to dispense oxygen) to well-meaning philanthropists helping non-governmental organisations to bridge the gaps in the fight against Covid.
At the other end, is an ugly face of humanity with unscrupulous elements exploiting the vulnerable. Central to it all is a titanic struggle between demand and supply for critical medicines, oxygen, ambulance services and even for sweet lime and coconut water with crafty middlemen making the most of it. Prices of many of these products and services have seen a 10-fold rise.
Desperate patients and their families, seeing little hope amid the gloom, reach out to anybody having any link with healthcare with prayers to help source a hospital bed, an oxygen cylinder or some critical medicines.
Sourcing onus with the patient
“This is shocking, very disturbing and so very unfortunate,” says Kiran Mazumdar-Shaw, philanthropist and chairperson of Biocon, India’s leading biopharmaceutical company. She feels, “the key reason for the problem is that the onus of sourcing critical medicines or oxygen, being left to the patient instead of the hospitals. These should all be stocked in the pharmacies of the hospitals and wherever there is central government control on the distribution of certain medicines then the hospitals need to work with the government and ensure that supplies are made available to the hospitals.”
Based on her own experience, she says, “if it is possible for hospitals to procure medicines like Itolizumab from Biocon, then it sure can be done for other critical medicines and equipment too.”
If a drug inspector does his or her job well but ends up confiscating the medicines or taking punitive action against the buyer (a member of the patient’s family), who is left desperate and to fend for self, it hardly helps in the midst of a pandemic. Some feel the focus could be to bring down the gap between demand and supply. Either there could be innovative ways to augment supplies or to channelize them in a fashion that the burden is not on the patient. The other option is to check unwarranted demand – for, not all patients need a long list of medications.
Checking Irrational Demand
A leading healthcare scientist and philanthropist who has been tracking the Covid-related developments in the country and backing efforts of development institutions at bridging the gaps in the fight against Covid-19, feels, one way to deal with the problem is to attack the unreasonable demand. Some of the medicines, he says, are still experimental drugs with no real data to prove their effectiveness and in fact, some could even prove counter-productive by producing gastritis in patients and reducing their dietary intake. Preferring to stay anonymous, he says, we need to check reckless over-treatment and long prescriptions and invest more in systems and interventions that can prevent patients from having the need to flood the hospitals. But then, there are challenges, if stringent penal action against indiscriminate medication were to be a solution to deter healthcare providers from taking the risks, physicians say, sometimes they are compelled to prescribe medicines because of pressure from the patient’s families and even if the doctors are not convinced with the effectiveness of an experimental drug, they point out that they just do not have the energy or the time to argue with the patients and end up prescribing them anyway.
Current needs, future approach
Responding to the concerns raised by his colleague in India on the rising greed and a tendency to exploit the current health crisis, Nobel Laureate Professor Muhammad Yunus, the founder of the Grameen model of microcredit that many from the Indian microfinance and financial inclusion sphere followed, says, “these unprecedented situations unleash the forces of good as well as evil.” The important thing, whether within the context of the virus or the other adverse developments, he says is “while we pay attention to the overwhelming needs of the present, we must not miss the opportunity for preparing for the future. We must come up with ideas and initiatives to make institutional and policy changes to make sure in future such things are not repeated.”
Or as Dr Rajiv Kumar, economist and the vice-chairman at the Niti Aayog, when asked for a view on the rapacious predators taking advantage of the vulnerable in these trying times, says: “what we need in the country is a moral renaissance that is able to make people put community interests ahead of self and see value in what Mahatma Gandhi always said: ends don’t justify the means.”
Why single out Covid?
But then, anyone who has tracked healthcare in India may argue there is no reason to single out Covid. After all, have we not heard in the past of black-marketing of drugs, fake medicines being sold and over treatment happening? They often argue that the real problem lies in not having a functioning system in healthcare for the poor and the middle class. Until the endemic problem of a rickety healthcare infrastructure and a faltering system is not corrected, these episodes will keep repeating and like the happenings at the moment, seem even more widely spread.