Make Healthcare the Priority
Dr Gautam Laud - M.D.S. (Oral Surgeon and Implantologist); Dr Indu Ballani, Consultant Dermatologist; Dr Bhaskar Mukherjee, Senior Consultant Psychiatrist, Founder & Director Neuromax Healthcare Ltd.; Dr Mamta Shah, Consultant Clinical Psychologist and Psychotherapist speak with Kavi Bhandari and Vasudha Mukherjee from BW Businessworld Editorial about prioritising healthcare, private hospitals and mental health during the crisis.
Vasudha Mukherjee: How can we strengthen the healthcare system?
Dr Mukherjee: For that, we need a huge budget allocation, state and central government support, and, infrastructure. We need to convert public auditoriums/stadiums into hospital space for patients. 99% of Covid patients need beds and oxygen, only 1% of Covid patient are more severe and require more attention.
Dr Ballani: We need to employ more people, especially for teleconsultations. There needs to be some system in place to assist at-home care at a more professional, more informed level. Most people are panicking and that panic can also cause oxygen levels to decrease in the body. More doctors who are not actively working can contribute this way.
Dr Shah: The Insurance Regulatory Development Authority of India had given health insurance companies till 2020 to include mental healthcare services in their packages. I think insurance companies are still having a hard time incorporating mental healthcare packages because it can be difficult to determine how much therapy or support one needs. In that department, we are still lagging.
Dr Laud: We need to formulate an independent body for healthcare and proper utilisation of funds is required. The country needs to have a healthcare body in place first before spending in multiple avenues that are not part of our needs. All our planning is coming in last minute, we need to be more proactive in our measures.
Dr Mukherjee: Mental health has already become a crisis. Those who are psychiatrists and front-line workers are finding that more severely affect Covid patients also psychiatric patients. The loss of loved ones, the loss of normalcy in society has created a tsunami of mental health problems. We do not have enough psychiatrists and psychologists. We are not at all equipped to handle this situation.
Vasudha Mukherjee: What parts of the healthcare value chain need more investments?
Dr Ballani: Right now, we need more manpower. The healthcare provider to patient ratio is very low. Our deficiencies in the healthcare sector are definitely being highlighted now.
Sudhir Mishra: All the sectors of healthcare need massive investment. It's one thing for people to die of Covid or related complication. People are dying because they have no remedy, medicine or oxygen. The issue here is the priorities of the country.
Vasudha Mukherjee: What is something we can do now, in the short run to help in the crisis?
Sudhir Mishra: You need to induct more people into the healthcare sector. Be it, nurses, in their final year of examinations, doctors awaiting certification, allow people from other countries to come. You have paramilitary forces, the army, specialised hospitals for different purposes. All of them need to join the covid team.
Kavi Bhandari: Will telemedicine and digital OPD help in the near future?
Dr Shah: Yes, it has been helping. Tele-psychiatry has also begun and I believe it helps create accessibility for people everywhere. The advantage is that patients can always come back.
Dr Laud: Most of the population is rural-based and instead of them having to rush to centres, most of their concerns can be handled via telemedicine from the comfort of their own homes. This can help reduce the load on hospitals, especially during this pandemic.
Vasudha Mukherjee: Is there any part of the healthcare sector that the government can still tap into for manpower during this crisis?
Dr Laud: There are about 2 lakh nurses who are already qualified to wait to give their final exams. One way to increase manpower would be to incorporate them into hospitals and give them a degree based on their performance instead of sitting for a written exam.
Dr Mukherjee: Some of the resources we can acquire are, one, the army, they have a huge medical corps that can be utilised right now. Two, the allocation of beds and three, every year India produces 70,000 MBBS students, we need to bring them as early as possible. Moreover, a large population of the Indian diaspora abroad is in healthcare, they are also trying to actively help. Until the bed and oxygen shortage is sorted out we will not be able to keep people alive.
Dr Ballani: Our medical system is state-dependent, which means it is the state’s responsibility to provide for its people. Right now, it's because it's an emergency. It should be dealt with at the central level, allocating more resources to the states, which are badly affected and then kind of distributing it evenly all around.
Kavi Bhandari: How can we get the expenditure on healthcare to 6% GDP?
Sudhir Mishra: Most developing countries spend around 4% to 5% GDP on healthcare, while developed countries invest about 7% to 9% /10%. In my understanding what is fundamentally going to change now is that society will start private investment in healthcare. So, we will go the USA way with a large healthcare infrastructure. Whether you like it or dislike its people have really made a lot of money during this crisis, so people will invest now.
Dr Mukherjee: In no condition is our state going to increase healthcare investment to 6%. We do not have social security, so with more private investments, our middle class will not be able to avail of that service anymore.
Dr Laud: Until and unless our priority is in healthcare it is impossible to get our GDP up to 6%. There is no dental insurance in India. That is the need of the hour, as people need good oral hygiene for their self-development. The government should work wholeheartedly into implementing this.
Kavi Bhandari: What should be the roadmap from now to building a robust affordable healthcare system across India?
Dr Ballani: As we have seen the GDP needs to be increased along with the allocation of resources. Private-public collaboration should be better since we have seen the private hospitals are doing well with handling the crisis. Since, they are not affordable for everyone, more and better insurance is required.
Dr Shah: In the mental healthcare sector, mental health has to be at par with physical health. A lot of people are not getting treatment because it's expensive, long term and there's a taboo around it. If both are seen as being at par with one another, the stigma around mental illness may fade.
Dr Mukherjee: Statue building is not our job, neither is having the world’s largest stadium. Our job is to have a sustainable population that have access to quality healthcare. For improving healthcare, we need social security.
Dr Laud: We need to start at the grassroots level. Increase the sanitation aspects and hygiene levels. It is important to hold politicians accountable for this. Also, we need to get a private body, independent of government control, recruit professionals who can formulate a proper structure and then implement it.
Sudhir Mishra: If you do not ask, then the government cannot provide. You have not asked for oxygen, or beds, you never made healthcare a priority.
Vasudha Mukherjee: How do we tackle Covid19?
Dr Mukherjee: If seen in perspective, Covid is the mildest pandemic of human history, Covid control is more about building up our defences.
Dr Shah: It is mild until it happens to you. The perception shifts from it being a mild pandemic to it being something huge that has happened to me. I think now one of the ways to tackle Corona. Pandemic is to again have a shift in perception to look inwards and look at yourself. The responsibility needs to be shifted from the outside to the inside.
Dr Laud: The fear factor needs to be reduced, which can happen with more knowledge and time. Second, the thought that after getting vaccinated we will be free to go out and mingle, is not true. You can still get infected despite vaccination. Open up registration and allow anyone who wants to get vaccinated, to have access.
Kavi Bhandari: What are your predictions for the next 30 days?
Dr Laud: If we do not maintain social distancing, nor provide vaccines to our population. If we do not increase the number of ICU beds, incorporate some form measures and increasing our force. The healthcare force, I think it's going to be a grim situation. We are in for another serious healthcare scare.
Dr Ballani: We should work more on reducing panic and educating people about the vaccines. It is everyone’s responsibility to get each other motivated about the vaccine.
Vasudha Mukherjee: What are you doing in your power to overcome this crisis?
Dr Laud: It is our duty to spread the word on the covid guidelines and vaccine. I make it a point to distribute free masks and education.
Dr Ballani: I am conducting a lot of teleconsultations. I make it a point to reach out to all my patients and check in with them to make sure they are doing well and not panicking.
Dr Shah: I think the most important thing is to understand that the fear and anxiety that we're going through is rooted in reality. You know generally, in my practice we get a lot of people with anxiety disorders, which it's not rooted in reality. The difficulty is that even the cases of depression are increasing because now people are losing people are. I think the important thing is to talk about it rather than keep it inside of them and have various storeys that you know emerging there.
Vasudha Mukherjee: What can the media do to help people?
Dr Shah: Normalise the fact that mental illness will be an outcome of this and it's alright to seek help and support.
Dr Ballani: Media can spread positive messages, such as survival stories.
Dr Laud: IF positive stories can be highlighted by the media it can help change people’s mindset.
