Friday, January 09, 2015

Being Mortal in India

A peaceful, painless death is one of life's greatest blessings.

Atul Gawande's latest book is born out of experiences with those who, for most part, did not have this blessing. It discusses the way in which medical technology and social norms tend to mislead, dictate or overrule the options available to those who are terminally ill.

The book also brought back deeply disturbing memories of my father's last days at a hospital in Kerala. Much like a patient described in the book, he to was shuttling between hospitals and diagnostic labs, with an irreversible nervous system failure. Towards the end it was appalling to see somebody who stayed away from hospitals "drugged into oblivion and tubed in most natural orifices as well as a few artificial ones".

Gawande, with his focus on the prevailing healthcare system in USA, misses on some of the more disturbing aspects of what the urban elderly face in India. The fact that my father retired from the central government service prolonged his suffering in more ways than one. The first question they asked you at hospitals was - "He is fully insured under CGHS, isn't he?".

A comprehensive health insurance package seems to have prompted private hospital docs to prescribe drugs, diagnostics and procedures that were completely unnecessary. Towards the end, all the family members had to give a signed undertaking to get him out of the ICU, back into the pay-wards.

The priorities of the elderly, and the terminally ill in India may be the same as those in other countries -- to avoid suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others,

The challenge is trying to ensure that these priorities take precedence over those of the doctors, the healthcare service providers, pharma & diagnostic companies, as well as 'loving' family and friends.


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