Dr. Sylvia Karpagam
For far too long, Dr. Devi Shetty has been giving advice on a range of things, the most recent being the Covid-19 pandemic. This is a crucial public health period for India, laying bare all the strengths and weaknesses of the system, and offering a significant window of opportunity to reimagine India’s public health system in a more comprehensive and holistic manner. Dr. Devi Shetty, a cardiothoracic surgeon and Chairman of one of the largest chain of corporate hospitals in Karnataka has become, and projected as, the singular advisor on all types of healthcare issues – a veritable one man army!
However, one little fact that gets sidelined is that, being a cardiothoracic surgeon by training, he is unlikely to have expertise in public health, epidemiology, statistics, planning, management etc. Secondly, being the Chairman of a corporate chain of hospitals, he has a terribly strong conflict of interest. Given a chance to ‘plan’ crucial budgets with public money, what are the chances that he will give up a wonderful opportunity to further the cause of the private healthcare sector? What are the chances that he won’t?
Even if one had to overlook these two things, it would be impossible to ignore that no genuine policy decision that has far reaching impact on thousands of people, can be taken without diversity or representation in decision making. Representation based on geographic, caste, class, gender, ability, sexual orientation etc. makes policies sound. No individual, no matter the stature he is elevated to, can take policy decisions or be the only consultant or stakeholder. Would this individual be penalised if the decision was found to be wrong? This is a crucial gap in accountability of’policy’ decisions in India, which in fact only serve the purpose of a select few. This is not the first time that decision making about public health in Karnataka has depended on one ‘hero’ who is given enormous control and who, invariably, also has a stake in the outcomes of the decision.
He starts by saying that, for simplicity, that he will plan Covid-19 facilities for Bangalore city. This is a fatal flaw in his calculation from the very word ‘go’. Bangalore is a city. It already has several private hospitals and most of the healthcare staff. It also has better testing and transport facilities. By reducing the discussion to Bangalore for the sake of ‘simplicity’ he has left out the rest of the state which has a very different situation than Bangalore. Comprehensive planning cannot just take a convenient sample.
After comparing India to Italy, he then he makes a sweeping statement that we should “follow what the UK government did by closing a few big government hospitals and converting them to dedicated COVID-19 facilities”. He then says that the Karnataka government should close two busy 1000 bed government hospitals in Bangalore and convert them to critical care beds. Firstly, most of the UK hospitals ARE government hospitals. So closing 2-3 or even 100 of them to convert them to Covid-19 beds is not the same as converting 2-3 of the ONLY tertiary government hospitals in the state into Covid-19 beds.
What he is doing with this ridiculous strategy is to put 1000s of patient lives at risk – many of whom are too poor to access any other care and have no power to challenge illegitimate decisions. It will be very difficult to convert these 1000 bed Covid hospitals back to super-speciality government hospitals again. How can one individual make such far reaching decisions?
After effectively planning a shut-down of the tertiary hospitals, his next suggestion is that the government should take care of those who don’t require advanced critical support while those who do, should be sent to large private hospitals to avail the ‘benefit of modern ICU’. After taking public hospitals out of the list of tertiary care providers, he has ensured that any patient requiring specialised care (henceforth) will necessarily have to go to private hospitals, which, lest we forget, have fought tooth and nail against any form of regulation. He then wants the government to procure (for private hospitals), cardiac monitors, ventilators and syringe pumps either locally or imported!!
He makes a statement that ventilators are crucial to preventing corona virus deaths. It is not good public health practice to reduce disease management to one piece of equipment. There are several treatment protocols that can actually reduce the need for a ventilator. Are these not ‘key’ to preventing coronavirus deaths? For coronavirus, prevention of spread is key. Protecting those at high risk from exposure is key. Early diagnosis of complications is key. Having well paid and well trained staff is key. Having affordable drugs is key. By saying ventilators are key, he shows what is key to him, and not necessarily for disease management or prevention
He then brings in a sweeping suggestion that MCI should permit online consultation and prescription. This is also an agenda driven proposal. In the current centralised model of private healthcare, illness is a business–more the patients, more the business. Telemedicine or remote consultation creates a way for highly specialised doctors to sit in their cosy offices in Bangalore, have ‘consultations’ with non-allopathic doctors or nurse practitioners, and then ask patients to come to Bangalore for further tests and management. This is exactly the model that has been pushed till now with disastrous consequences. Even before the lockdown, patients and attenders have had to travel to Bangalore for conditions that could have as well been managed very close to their homes if planning had been coherent. To push this agenda now, on the back of Covid-19 should be condemned.
He then makes sweeping statements about India being an ‘example for the world to follow’. Indian public health is in too much shambles for any of us to pretend otherwise, but this is precisely the reason why he is on every committee and task force. He helps the government LOOK good and also makes the elites FEEL good. Unfortunately, preparations for Covid-19 requires more than just a feel good person. It requires people who represent patients, a majority of whom would never have, or ever will, fit into the illusory fantasy of India that Dr. Devi Shetty is projecting. India cannot boastfully compare itself with developed countries, or worse, replicate the exact same models here. Transplantation may work for hearts, sir, but it won’t work for health systems.
There is need for a great deal of humility and consultation with diverse stakeholders, no matter how difficult that process maybe. Only an honest appraisal of the current situation, an acknowledgement that much needs to be done, and a wide range of consultative processes can prevent and control the possible adverse impact of Covid-19. Unfortunately, neither ventilators nor cardiothoracic surgeons are a solution.
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References
https://fit.thequint.com/coronavirus/a-veteran-doctor-responds-to-dr-devi-shettys-plan-to-tackle-covid-19-india
https://www.businesstoday.in/opinion/columns/coronavirus-in-india-covid-19-pandemic-hospitals-doctors-patients-icu-china-italy-ventilators/story/398920.html
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Dr. Sylvia Karpagam is a public health doctor and researcher who is part of the Health for all campaign.
