India’s Healthcare System Is Suffering From a Crisis of Compassion

Even 70 years after the Bhore committee recommended that a doctor should be a ‘social physician protecting and guiding the people,’ most Indian doctors are yet to take over that mantle.

Representative image. Credit: Asian Development Bank/Flickr (CC BY-NC-ND 2.0)

Representative image. Credit: Asian Development Bank/Flickr (CC BY-NC-ND 2.0)

Every year, July 1 is celebrated as Doctors’ Day across India. In the last few months, there has been unprecedented violence against doctors leading to strikes and agitations in many parts of the country, so let us try and see if we can decipher the recent events through a historical perspective.

Sir Joseph W. Bhore was the chairman of the Health Survey and Development Committee – formed by the colonial rulers of India in 1943 with an aim to evaluate the then existing health conditions and health set up in the country, and give recommendations for the future. Dorothy Porter, in her immensely useful book The History of Public Health and the Modern State, described the formation of this committee as a ‘crisis of legitimation’ by the British rulers, as after the end of the Second World War, there was significant failure of health services across the country.

The committee submitted its recommendation in three volumes in 1946, a year before independence. It severely criticised the health status in British India and brought to light the dramatic comparisons between the values of important health statistics (like infant mortality and life expectancy) in England (and Wales) and in India. Majority of recommendations of the Bhore committee had a preventive narrative but there was an emphasis on the integration of preventive and therapeutic services at all levels.

In one of its most far-reaching verdicts, the Bhore committee had borrowed the words of the famous Swiss medical historian, professor Henry E. Sigerist, to say that the doctor should be a ‘social physician protecting and guiding the people’. To me, this was the soul of the numerous recommendations of the committee as it had more to do with the individual member of the healthcare delivery system rather than a means to run the administrative machinery of healthcare.

Even 70 years after it was recommended, the Indian doctor is yet to take over the mantle of a social physician and a leader protecting and guiding the people. In fact, the medical fraternity has hardly ever attempted to take this role seriously in postcolonial India, barring a few exceptions. Is that a lack of will of the Indian doctor or a lack of understanding of the basic tenants of socialistic parlance within the realms of the Indian society which led to this failure, is debatable.

I won’t be wrong in concluding that medical students in India are kept away from this aspect of training where they can be sensitised to the needs of the poor, the underprivileged and the down trodden of the society – the sections which are most in need of a ‘social physician’ and a leader. The three months of rural posting (after MBBS) which was started following the recommendations of the Bhore committee with this very objective, is too little and inconsequential in evoking any sense of understanding in the minds of these budding doctors to take over as social physicians and community leaders.

The materialistic lure, better job opportunities and poor understanding of the operational complexities of the Indian society, are some of the causes which prevent the development of  ‘social physicians’ from amongst this group. It may be argued that to be a social physician as recommended by Bhore, it is not necessary to be only practicing in the rural hinterlands of the country and rightly so. The ‘social physician leader’ can evolve anywhere. It is not the place of practice for a doctor that makes him/her a leader but rather a sense of compassion towards the subjects he/she is bound to take care of – an understanding of the fact that the diseased are always more important than the disease.

In a country that sees more than 1,500-2,000 trained doctors migrate to foreign soils every year, how do we arouse compassion and train them to fit into the role of a ‘social physician’ is the question, which unfortunately does not have a clear-cut answer. So from a ‘crisis of legitimisation’ at the time of inception of the Bhore committee, we have landed into a ‘crisis of compassion’ in the present day.

Having said this, despite a reluctance of the Indian medical fraternity to serve its own people with the zest of a social activist, there are examples from India itself where doctors have taken over the role suggested by Bhore and his committee. People like Dr. Binayak Sen, Dr. Abhay Bang and Dr. Rani Bang, the doctors at the Jan Swasthya Sahyog and Dr. Abhay Shukla are some of the names I can recollect from the present generation. These are individuals who have gone beyond the precincts of conventional thinking and action and have taken up healthcare not only as a means of preventing and treating disease but also as a weapon to fight for the rights of the weaker sections of the society, train them to stand for their cause and thus emerge as leaders for large segments of Indian populace.

The practice of medicine gives an opportunity of changing the society from within. So on this Doctors’ Day, India’s medical professionals should realise that beyond the lures of pharmaceutical industry and tons of capital, lies an unexplored horizon of hope. To evolve as social physicians of Bhore, along with the science of healing, we need to learn the art of compassion. In the words of Hippocrates, the father of medicine, wherever the art of medicine is loved, there is also a love of humanity.

Shah Alam Khan is professor of orthopaedics, AIIMS, New Delhi. Views expressed are personal.