The assurance of the availability of doctors and the promise of free tests and medicines has made the Aam Aadmi Party’s mohalla clinics quite popular with patients, as was obvious from the wait time of half-an- hour to more than one hour at the locations I visited.
Delhi’s Battle Against Diseases
The disease profile of patients, which the clinics collect and upload via apps on smart devices, can help the government devise preventive health strategies. The government has engaged the WISH Foundation, an NGO, to do the analytics for which software is being devised, an official in the state health ministry said.
But unless there is coordination among the various departments and the municipal corporations – not to mention earnestness about sanitation and hygiene – infectious and lifestyle diseases will continue to trouble the city.
And in 2015, it has the largest share of dengue cases at 15,867, or 16 percent of the total.
Boon for Local Residents
The AAP government has set up 158 mohalla clinics since the first one came up at Peeragarhi in July 2015. Sites have been identified for 470 more, an official in the health ministry said.
The government plans to have one in each of the 380 urban villages in the capital and about 15 in every assembly constituency. Eleven logistics hubs have been planned, so that medicines do not have to travel more than 15 kilometres during the last stretch.
Susheela Devi, 70, who was at East Delhi’s Saraswati Kunj mohalla clinic for tablets to numb chronic pain from sciatica, said she had voted for the “jadoowala” in the state and municipal elections – referring to the broom, which is AAP’s symbol. She said she had moved from Aligarh and was a “khattar” (staunch) BJP voter. As if to underline her leanings, she exclaimed, “Why have you given her a Muslim name?” when the mother of a child said “Sofia” in reply to her question.
Sofia’s mother, Anju Kumar, had come with her husband, Vikas, who works in the housekeeping department of a hotel in nearby Patparganj. “Bahut sakoon hai,” he said, referring to the mental relief he credits the mohalla clinics with for having saved him the anxiety of consulting private medical practitioners who charged an arm and a leg. The quality of care was good, he observed, and the medicines were free.
In fact, free medicines are quite a lure. India ranks high among countries in terms of out-of-pocket medical expenses, with people dipping into their own wallets to meet 70 percent of the cost. Of this, 70 percent is spent on drugs.
Without free outpatient care, poor people tend to neglect diseases in the initial stages, increasing the risk of catastrophic spending when they fully manifest. The expert group on universal health coverage, set up by the erstwhile Planning Commission, had recommended free provision of medicines at primary healthcare centres.
Kiran Trivedi, who hails from Bihar, works as a domestic help. She says she preferred the Ganesh Nagar Mohalla clinic to the government dispensary because of the doctor. She had been waiting to see Preeti Saxena for more than an hour.
Long Queue of Patients
Dr Saxena, the medical practitioner, told us that she was earlier practising at the family welfare centre of a government-aided NGO. She would log in six hours, and leave at 3 pm, well past the closing time of 1 pm. No, she did not do private practice. Examining between 102 and 160 patients a day was quite stressful in itself.
There were many cases of common cold, fever and dengue in the ante-room. People from Ganesh Nagar were calling in with gastrointestinal infections because of contaminated water supply. Lifestyle diseases like hypothyroidism, hypertension and diabetes were quite prevalent, Saxena said.
The clinics offer 212 free tests. Those for dengue were quite expensive and cost a few thousand rupees. The government had engaged a private lab to collect samples between 9 and 10:30 am. Dr Saxena did not have a nurse to administer injections. Such cases were referred to polyclinics.
Doctors Shuffling Between Govt Job and Pvt Practice
The mohalla clinic at Trilokpuri was like a carnival, with no respite from patients. This colony had been forcibly “resettled” with slum residents from across the River Yamuna by then Lt Governor Jagmohan during the Emergency in the mid-1970s in a drive to beautify the city. The colony was not what it used to be. The streets were paved with cement concrete and swept clean, the skyline had risen as the residents had built additional storeys. And with ownership, had come pride: this was obvious from the way the houses were dressed up.
The doctor, Uday Kumar, was a workaholic. From 9 am to 3 pm, he was at the clinic and then at a private hospital in Noida from 9 pm to 8 am. Did he get enough sleep and rest in the six-hour break?
Dr Kumar said he was used to working 17-18 hours since his student days in Bihar. He was an activist then, participating in strikes and rallies, some of which were even violent. He wasn’t sure what he wanted to be then. For five years he had studied Ayurveda and then done a three-year course in homeopathy before heading to China where he obtained an MBBS degree from Chongqing University.
The activist in him was not dormant – he was vice-president of the AAP’s medical cell. A notice on the door urged patients to call 1031 if the prescribed medicines were not available. He ensured that the clinic was stocked with drugs.
‘Professional Satisfaction’ by Practising Community Medicine
At the Todapur mohalla clinic in West Delhi, the doctor, R Pal, spoke of “professional appeasement” he got by practising community medicine. He had retired as the chief medical officer of a municipal hospital in New Delhi area, but that job did not give him the satisfaction he now gets. His clinic is a large rented hall in an urban village with narrow lanes, where patients sit on benches.
An automated vending machine dispenses medicines. Dr Pal gives time to patients – he does not like to see more than 80-90 patients a day, for which he gets paid Rs 30 each.
Sitting in an area of ‘sub-clinical infection,’ he can see diseases as they incubate and become full-blown ailments. At the hospital, he was more of a consultant, his vision was narrow he said, and he was treating patients with fully manifested diseases.
(Vivian Fernandes is the editor at www.smartindianagriculture.in.This is an opinion piece and the views expressed above are the author’s own.The Quintneither endorses nor is responsible for the same.)