Why I chose to let Pishi die in peace in her mud home than

getting treated at a public hospital?

Or
Between life and death the untold stories of being a
migrant house help.
In her death was a question pondering on the stark reality of
glorified India, answer to which lies in questioning the dichotomies
of development and the erosion of the public interest.
Lying like a feeble soul on the blood smattered floor of a public
hospital in urban Kolkatta, dear pishi was striving for life at the age
which still remains a mystery but she believed she was at least 65
or may be 70! Hailing from a rural part of Bengal now probably a
part of the neighbouring country of Bangladesh she had seen it all,
the independence, which never freed her from bondage, the wars
that never eased her daily struggle. From the quaint distant village
she travelled years ago to Delhi to evade the extreme lashes of
poverty and betrayal that she had witnessed in her lifetime.
Far away from her home she found happiness in kids who she never
biologically produced but on whom she showered love in abundance
and with utmost honesty. For many Pishi was just a domestic help,
but for us she epitomized the thread that binds the family with love
and care. For years she was the one who held the strings of the
family tight as my parents strived hard to balance their work and
life. It was only the sudden revelation of her cancer that left the
family shaken and almost orphaned. Though, we did not leave any
stone unturned to get her best medical services available yet her
final choice was to die in peace than suffer the apathy of the
crumbling state run Medicare facilities.
I chose to write about it not as an obituary but probably as a
concerned citizen who remains unnerved by the realities of the
largest democracy and the overdependence on private sector for
providing noble health care facilities at the cost of exploiting the
vulnerable.
To set the context- Below is a snippet from the letter that I wrote to
the CM of West Bengal with no hope of an answer and as expected
there was no answer but nonetheless it was important to speak.
I happened to visit RG KAR recently to continue the line of treatment of Pishi who
had been fighting with periampullary carcinoma in lay terms pancreatic cancer.
Her first phase of treatment was successfully completed at AIIMS and I must
credit the team of doctors who at every step cooperated, empathized and
dedicatedly made an attempt to treat the patient despite various challenges and

hurdles. Probably because of the reference that worked but nonetheless the
credit is theirs.
Sadly, due to circumstantial pressure we had to choose to continue the line of
treatment in Kolkata (her hometown) for the last leg of the treatment. Due to
proximity reasons her family showed faith in RG KAR medical college and from
family and well-wishers in Kolkata we confirmed its credibility. I only wish I could
vouch for the same as what I saw in RG KAR was not just poor infrastructural
issue but inhuman conditions in which the patients are being treated.
What I witnessed around me was not just an awful reality of a broken health
system but also negligence of the state in setting up accountability
mechanisms. With one forced to carry bleeding and bruised patient in arms due
to paucity of stretchers I saw people fighting for one single stretcher that they
could trace after almost completing a round of treasure hunt. It would have been
comical if it were not happening to one of us. Infrastructural provisions, which are
as minor as availability of stretchers cannot be attributed to paucity of funds,
rather sheer lack of effective managerial procedures.
Visuals that I saw inside the hospital still haunt me.
Given the paucity of beds patients are forced to lie on the floor with just a
plastic rug as their bed. To me it appeared as if everyone making an
attempt to walk on that floor is trying his or her hand at football (Bengals
favorite game). Only difference instead of a ball they kick needles, blood
stained cotton swabs, empty bottles of medicine and at times the
patients lying on the floor.

With zero sanitation level, I wonder how the doctors manage to evade
diseases forget about the condition of the patient who surely gets a lived
experience of hell even before succumbing to their disease!
I am not even getting on to describing the condition of the toilets,
which probably are worse than a Gobar Gas Plant.

This whole incident left me besieged with thoughts on the

bewildering state of health system that is moving beyond the realms
of affordable and inclusive.
1. What happens when publicness of public service degrades?
With narrowing composition of public service beneficiaries,
accountability of public service declines gradually eroding the public
trust. What does this mean in the context of health? For a country
where health policies are failing to benefit the poor and are in sync
with the private players the impact on the social impetus is
appalling. As government fails to deliver the public good an over
bearing dependence on the private increases. In the context of
health this means that the lack of trust on public hospitals pushes
the powerful and questioning middle and upper middle class to seek
services from the private, thereby leaving the poor and marginalized
to be the major support seekers at the public hospitals. This has a
severe impact on the accountability of the public institutes.
2. Is negative co-relation between unskilled migration and access to
health services for below pyramid migrants a policy flaw?

In 2001, the Census reported 309 million internal migrants. Of these

migrants,
70.7 per cent were women. Most of the internal migrants are
unskilled and poor migrants who are on the other end of the
spectrum in the value chain based Medicare facilities. While there
has been a pressing need to responsive policies that see right to
health care from a human rights perspective the healthcare
landscape in the India has witnessed a paramount shift towards
privatization. The decay of the public health care has in turn paved
way for the privates to grow and despite being mandated to provide
inclusive health care services the exclusiveness of the private
hospitals is an unhidden reality. Despite the fact the Delhi Court
mandated free treatment for Economically Weaker Section (EWS) for
Delhi NCR region, reports of hospitals violating the obligation have
been reported and personally experienced. This leaves huge
question marks on accessibility and quality of treatment especially
for the disadvantaged migrants.
3. Are we forgetting being human and the reality of mortality?
The word cancer had infused a sense of panic and every time I
spoke to the team of doctors a sense of hope overtook the reality
waiting in the shadows, as I knew Pishi would soon pass to light. To
let her die with grace was a tough choice. The mirage of the
palliative Medicare facilities was enwrapping as a soft delusional
blanket comforting the reality of death. The day I saw her lying on
the in the gory floors of the public hospital in Kolkatta the glory of
the medical science failed to romanticise the idea of life and
longevity any further. Shedding the arrogance of medical miracles
and accepting the traditional realities of life is truly a challenge
posed by the modernity of technology. While I have seen a few in
my family and friends succumb to cancer behind the shiny doors of
the ICU, the lack of affordability had pitched a paradox within which
I found the stippled reality of life.

LETTER TO CM of WEST BENGAL

Respected
Chief Minister West Bengal
Ms. Mamata Banerjee
Let me begin by expressing my respect for your zest and energy to initiate the much-desired
poriborton that state of West Bengal was stripped off since many years. It is this zest of
yours that gives me the hope to write to you about the state of the state, which I loosely
belong to. I recently visited Kolkata probably after a decade and was on a mission to make
one last attempt to save my ailing Pishi who had worked at our place for past 25 years.
For many of my friends who hail from various parts of the world the Kolkata is an interesting
mix of culture, heritage and development. I would have affirmatively asserted that city
stands by their expectations and has managed to be a true welfare state had I not been a
first hand witness of the implications of poor infrastructural support at one of the leading
medical institutes in Kolkata.
I happened to visit RG KAR recently to continue the line of treatment of my dear Pishi who
had been fighting with periampullary carcinoma in non-scientific terms pancreatic cancer.
Her first phase of treatment was successfully completed at AIIMS and I must credit the team
of doctors who at every step cooperated, empathized and dedicatedly made an attempt to
treat the patient despite various challenges and hurdles.
As a result of circumstantial pressure we had to choose to continue the line of treatment in
Kolkata (her hometown) for the last leg of the treatment.
Due to proximity reasons her family showed faith in RG KAR medical college and from family
and well-wishers in Kolkata we confirmed its credibility. I only wish I could vouch for the
same as what I saw in RG KAR was not just poor infrastructural issue but inhuman conditions
in which the patients are being treated.
What I witnessed around me was not just an awful reality of a broken health system
but also negligence of the state in setting up accountability mechanisms. With one
forced to carry bleeding and bruised patient in arms due to paucity of stretchers I saw
people fighting for one single stretcher that they could trace after almost completing a
round of treasure hunt. It would have been comical if it were not happening to one of us. I
am sure you would agree that infrastructural provisions, which are as minor as availability of
stretchers cannot be attributed to paucity of funds, rather sheer lack of effective managerial
procedures.
Visuals that I saw inside the hospital still haunt me.

Given the paucity of beds patients are forced to lie on the floor with just a plastic
rug as their bed. To me it appeared as if everyone making an attempt to walk on
that floor is trying his or her hand at football (Bengals favorite game). Only
difference instead of a ball they kick needles, blood stained cotton swabs,
empty bottles of medicine and at times hands of the patients lying on the
floor.

With zero sanitation level, I wonder how the doctors manage to evade diseases
forget about the condition of the patient who surely gets a lived experience of hell
even before succumbing to their disease!

I am not even getting on to describing the condition of the toilets, which

probably are worse than a Gobar Gas Plant.
I am sure for someone who manages the state quite well you must be well acquainted with
the conditions of the public health institutes all across the state. But, for someone who has
done some amount of travel in at least some districts of India and has managed to take a
sneak peek in the public health services offered, the state of RG KAR was a nightmare.
As far as Pishi is concerned she lost the battle and chose to transcend to light.
Despite her yearn to live she chose to die peacefully on the cot outside her mud
home than the floor of a filthy hospital which as per her was a night in Hell.
I write to you with hope that given the broken structures of the state that you have been
trying to refurbish you surely have managed to reinstate the lost hope for many in good
governance. I am hoping you would take cognizance of the issue and ensure steps are taken
towards not letting a patient die of the fear of the condition of the public hospitals in Kolkata.
I hope you will not disappoint a citizen who still partially believes that the elected members