Sunday, October 25, 2009

Street Medicine

This week I got my first, first-hand taste of the Indian medical system. I'll start with the story of how I came to require medical treatment.

I was at the bus stop near my office waiting to catch a bus home. I was on the phone conducting some business for work when the bus came. The next few moments are harder to piece together. I remember climbing onto the first step of the bus entrance, with one hand gripping the rail and the other still holding my phone. Then a guy comes flying in from behind and crams into the entrance before I had fully gotten in. And of course the bus has already started moving because "bus stop" is a very loosely interpreted concept in India.

Anyway the guy somehow wedges in such a way that I lose my grip of the rail and go tumbling out of the bus and crash onto the dusty pavement. My right chapal goes flying off. Without much hesitation I pick myself up, get my chapal, and walk back to the bus, which had stopped a little ways ahead. I get on and between trying to gather my bearings, dust myself off (I was covered), and trying to ask the guy what the hell he was thinking, I didn't notice a bloody, dirty clot of blood which had formed on my right elbow. I reached in my bag to find a napkin, but the best I had was a pair of boxer shorts I had packed in case I would be staying over at Ba's that night. After cleaning up the wound a little I notice that the there was a sizable indentation in my arm, a hole, like a big chunk of skin had been bitten off. At about that point it started to pain.

I went home and after Uncleji did some first aid he drove me to a local doctor. Dr. Oza, M.B.B.S.'s office was in a strip mall type location typical of small businesses in Indian metros . Next door were a vegetable stand, bakery, tailor, and a grocery store. Dr.Oza's place had a waiting area in front and then an office behind a glass wall. Dr. Oza led me to the back of the office where there was a shoebox of an examining room. The original idea was to get the wound cleaned and bandaged, and to get a tetanus shot. But after looking at the wound Doctor sahib declared that I needed stitches.

Thus began the series of events that lucidly illustrated to me what made medical care in India so different than in the States. Back home, everything is official, there are appointments, insurance cards, forms, charts with medical histories, more forms, thermometers that the nurse sticks in your ear, butcher paper over cushioned examining tables in private well-light examining rooms, and all the rest. Here there was a doctor in a small office with no staff. He had no stethoscope, not even a white lab coat. His equipment was all in an old-school hardshell suitcase which he popped open and worked straight out of. When he said I needed stitches, I was thrown off because there were so many steps that according to my sense of the world had been skipped. I was never asked my name; I filled out no form. I wasn't asked about medical insurance, or about my medical history. I was not called in from the waiting area by a nurse and my height and weight and blood pressure were not taken. It was all so raw, so street.

I paused and asked him how much the stitches were going to cost. He thought for a half second and then said Rs.150. I was mind-boggled. Three dollars! He told me that if I went to a hospital, it would be 3-4K, so I'd be getting a good deal with him. Ya think? I told doctor sahib to do his thing. He pulls out a thick black thread and some scissors and tells me to lay down and just stick out my arm in the air. He is not wearing gloves, and he administers no anesthesia (he didn't offer). He then proceeds to put two stitches into my wound. I was calm, though of course it hurt because he did not numb me. I didn't even know it was possible to get stitches without anesthesia. I look away for most of it with my handkerchief over my eyes, but get a glimpse of the dark gray metal hook-like apparatus he apparently used to make the holes. It reminded me of the torture implements in that part in Braveheart where that clergyman lifts a cloth and shows Wallace what he's about to use on him.

After the stitches Doctor sahib tells me to take down my trousers and administers a tetanus shot in the ass. We then sit at his desk where he writes out a prescription. Hand written on custom
stationary . He writes for 3 days supply of antibiotics, painkillers, and anti-acid to combat the side-effect of the antibiotics. I pay him Rs.250 cash for the stitches and shot. He gives me change from a wad of cash in his shirt pocket.

Uncleji drives me to another street-side strip mall where there is a chemist's shop to pick up my
drugs. The shop sells shampoo, body wash, deodorant, toothpaste, and prescription medication. The guy at the counter takes my hand-written prescription and goes to a shelf in the back to fetch my drugs. He didn't question the authenticity of the paper. I didn't have to prove my name was the one on the paper, nor was I given any instructions on using the medication. It was like ordering a burger and fries at a Burger King counter. After telling me they didn't have any of the anti acid drug in stock, they said not to worry; I'd be fine without it. Needless to say these guys were not doctors nor pharmacists. I paid Rs.300 for my drugs. And that was that.

This was an eye-opening experience for me. The process was both smooth and disconcerting. It felt too easy, though I'm pretty sure I got everything I needed. Cost-wise, I had the cheapest medical experience an American can ever possibly hope to have (about 12 bucks all in). And coincidentally all this while a health care debate rages back home in which an important component is (or at least should be) the exponentially-rising cost of health care for ordinary folks. I just finished listening to a pair of radio programs that wonderfully break down the problem in vintage TAL-storytelling style. Are the rising costs due to doctors who are incentivized to use expensive procedures? Or patients who believe more treatment is always better and/or pressure doctors with malpractice threats? Or insurance companies that charge exorbitant premiums and then use rescission to not pay out? Or medical facilities that use dominance in local markets to exploit the emotions of patients and demand high fees and cost-shift private insurers? Whatever the root of the problem, I now know that in India there is a model that somehow results in cheap, accessible medical care: street medicine.

A few days before the bus incident I was walking near my place and a woman on a scooter stopped me to ask how to get to the Anandniketan school. Remarkably, I actually knew where it was. I proceeded to casually give her the directions and soon she was on her way. I walked off in my direction with head held high, smiling to myself. I had finally made it; I was officially a local in this foreign land. There was a visible spring in my step. But after falling out of a city bus and busting my elbow, there is no longer any spring. Rest assured I've humbly re-assumed my role as an outsider, confused foreigner in Ahmedabad.


  1. what is with you and people giving you stiches? :-) glad the 4 hour new year's eve hospital wait was averted.

  2. Street medicine.... as long as the doctor got skills.... it's great! they should have a Mobile Phone rating system... so after you get treatment, you can rate the doctor. Before you go see a doctor, you can check his/her rating on your phone.... what do you think?

  3. First New Year's and now this?! I've had enough. Where is this guy who pushed you off the bus? Nobody touches my Neil. I will look for him ...