<p>Medically speaking, bodies can be classified into healthy and sick. But there is another kind of inscription the body carries: rich and poor. One particular combination — poor and sick — can be fatal. The sick poor who visit Delhi’s government hospitals are well aware of this.
Rukhsar lives in Navjeevan Camp, one of three slum “camps” in Kalkaji ward of south Delhi. She is 24 and the daughter of Baby, a research collaborator and friend.
I have known Rukhsar since she was a child, and she is now near the end of her fourth pregnancy.
This has been a difficult pregnancy. Since December, discussions about where to take her for the delivery have caused friction in the household. Her husband Billal keeps saying that he is not like other slum-dwellers and can afford private health care for his wife. Rukhsar’s mother Baby is a hardened slum resident who left her husband at age 22, moved into the then-new slum, and raised her daughter while doing domestic work. “It is not about the costs only,” she says with her usual cynicism, “it is also about the best service.”
For the regular pregnancy checkups and tests, Billal has chosen a nearby private clinic. Lately, however, Rukhsar has taken ill several times, with severe abdominal pain, and the private treatment has not helped. One day Billal is away at work and Rukhsar is writhing in pain, so Baby rushes her to the All-India Institute of Medical Sciences (AIIMS). She gets immediate attention, which brings relief, but is then referred to Safdarjung Hospital for a detailed checkup on the following day.
So I am summoned to help. Billal and Baby will take turns to babysit the other three children, while Rukhsar and I spend the day at the hospital. Billal lacks the courage to challenge his mother-in-law and a prescription from AIIMS. “The doctors there have studied in Paris and London,” Baby scolds, “and you, selling vegetables in Okhla, think you know better!”
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Rukhsar and I reach Safdarjung at 8 am. The registration room is already choc-a-bloc. Security guards are managing the crowds. They use loud, often foul language and shrill whistles. Anyone spending more time than deemed necessary is told to hurry. This includes the few seconds spent asking questions about the hospital process or about which department to get a registration slip for. “Loitering” — such as two women standing together in a queue — bring severe criticism.
I get the slip and we head towards Gynaecology & Obstetrics. There are many queues, and we do not know which one to join. After much questioning and observing, I crack the code. Women wanting an audience with the doctor have to get their urine, blood, blood pressure, height and weight checked first. We take turns to stand in the longest queue while Rukhsar submits and then deposits her sample.
Soon I am the unofficial guide. Women watching me with Rukhsar approach me. Some have been standing in the wrong queue; others don’t know Hindi; for some, this is their first time in the big city. Some are in obvious agony, but because their husbands are not allowed inside they have to drag themselves around on their own. Not one of the staff offers any help, consolation or sympathy.
A few altercations, lots of queueing and three samples of urine and blood later, we find ourselves in yet another queue, this time to see the doctor. It is past 11 am and the crowd is getting anxious. The Out Patient Department closes at 1 pm and women are worried their turn will not come. Then they will have to take another day off work, pay the bus fare, find someone to tend to the children and, quite possibly, still get no relief from their discomfort or pain.
Our turn comes. Only the patient is allowed into the doctors’ room. I stand at the door. Two patients at a time are seen by two doctors. The doctors, both young women, are curt and rude. They ask a few questions and discuss the case in English, a language their patients do not speak. They scribble details of medical history, ailments and treatments without so much as exchanging a word with the patient. These details are written in English, in the usual doctor’s scrawl.
Some patients want to know what illness they have, and to ask about it. The doctors retort, “You think you are the only one here? If you want special service, go to a private hospital.” I hear them talking, in English, about the ignorance and uncouthness of the patients.
Outside, a few women ask me to decipher the doctors’ handwriting. “What is wrong with me?” they ask. “What kinds of tests do I need? Where do I go?” Surely the doctors, doing their postgraduate work in India’s premier medical institute at the taxpayer’s expense, ought to give some information at least in Hindi? It is not as if they do not speak the language.
Rukhsar asks, “Didi, to vomit means to throw up, isn’t it?” When I say yes, she breaks into hysterical laughter. “The doctor madam kept asking the patient in front of me, do you have vommm-iii-ting. The woman did not know what that meant and kept saying, what? After the fifth time, the patient lifted her sari, pointed to her socks and said exasperatedly, yes, I am wearing panties, socks and other things.”
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A few days later Rukhsar is rushed to the hospital again, this time to Emergency. Her abdominal pain has become unbearable. She can hardly walk, but Baby and I are not allowed to help her into the ward.
In the waiting area I notice a wirebrush-haired, skeletally thin woman in a hurriedly wrapped sari, hugging herself and swaying. There are two men and a woman with her. They are in anxious conversation. I look closer, and notice that her feet are soaked in blood, and that she is sitting in a pool of blood.
I ask the woman with her, who is her mother, why she has not been rushed into the ward. One of the men explains, “The women are from rural Bengal. They don’t even understand Hindi.” But why is she not being treated? He says, “The woman is having a miscarriage, four months into her pregnancy. She is bleeding heavily. When we brought her here, they took her in but said they will only admit her and administer treatment if the next of kin will donate blood.” So what is the problem? “That man, her husband, refuses to donate blood.” Standing near the woman I can see the desperate state she is in. Her blood is not dripping but flowing.
She signals to me and I squat. She puts her dry lips to my ears and says something which I do not catch.
I give her mother Rukhsar’s bottle of water. Then I try to convince the husband to donate blood. He says he is afraid of needles and fears for his own life if blood is “sucked” from his body. I can see that his ears are intricately pierced, so I point this out to him and tell him angrily that if he does not donate blood it will be fatal for his wife. Nonchalantly he says to the crowd which has gathered, “I will get another one.”
This is when I, and the crowd too, cannot contain our anger. I phone the police, telling him that if his wife dies he will be held liable. No threat moves him. There are two female guards at the entrance. The scene has unfolded in front of them, but when I ask them to take the patient in because her situation is dire, they refuse. Rules are rules. I offer to donate blood, but they refuse.
With a woman bleeding herself to death a few feet away, I play the class card. I switch from Hindi to outrightly abusive English. This works better. I shout, isn’t it obligatory for a public hospital to give emergency treatment? Is it her fault that she has an inconsiderate husband? I demand to see the chief medical officer. I claim to be a journalist.
By now doctors and police have arrived. The doctors ask me to cool down. I in turn demand that they admit the bleeding woman. Again I offer blood. They say no. With the woman finally taken into the ward, I leave the policemen to deal with the husband.
Rukhsar has left the emergency ward. They have refused to admit her, saying her condition is not sufficiently serious: “Come when you cannot bear the pain.”
For once Billal and Baby agree. We rush Rukhsar to a private hospital. There she is seen by Nudrat, a young Muslim woman doctor from Bihar. This doctor speaks in faltering English but we can all understand her. She comes from a poor farming family and has fought her family’s prejudices to study medicine, on a scholarship, at Jamia Hamdard University.
With Rukhsar recovering, Baby and I wish fervently for more people like Nudrat. We smile at each other as we take turns to rub Rukhsar’s feet.
Baby has only one complaint. “The next time you shout at them,” she says, “will you do it in Hindi? Let them be shamed in front of us in a language which we understand. They should know that we know.”