A Canadian in an Indian Hospital

I am from Canada. My experience of going to any hospital system anywhere in the world is with Alberta Health Services, with special mention to Grey Nuns hospital in Edmonton my hometown. I don't want to go to any hospital, but should there be any need, I trust any Canadian hospital to take care of me.

The Canadian health care system is not perfect but it is still the envy of many countries including the mighty USA and way better than what I recently experienced in India. I can live with some weaknesses in our universal care system like - lack of prescription drug coverage and unacceptable wait times for some surgeries in Canada. These irritants are nothing compared to what you will get once admitted to any Indian hospital. Compared to India our system is more like the Garden of Eden.

In Canada all I need to remember is to dial 911 or have somebody dial it for me, keep my AHCIP health care card number ready when asked and I will be cared for, no matter what the problem is. While I am transported to the hospital, medics will save my life, without asking for money in return. In the hospital, admission staff will never ask me to deposit cash before any doctor sees me. My federal and provincial taxes take care of my bill. I can talk to my Doctor and discuss anything pertaining to my illness and I will not have to leave my bed worrying how and where can I get this medicine.

Long live Canada’s universal healthcare program. Thank you Tommy Douglas. For people outside Canada who want to know the legislative background of our system refer to Frequently asked questions about Canada Health Act of 1984

Indian Summer of 2021

Covid second wave. Recently in this Covid era, when my Dad had to be rushed to an ICU in a small town in India, I had a front seat view of how the hospital system in India works and I  appreciate what we have in Canada. 

Here is what I had to undergo and pretty much my experience mirrors what other people would have experienced, if not worse. 

First things first,

1. In a medical emergency, there is no 911 type national number to report and request emergency care. The ambulance system, if it exists, is untrustworthy and if they do arrive at your doorsteps don't expect any preliminary medical aid (think stroke, cardiac arrest) inside the vehicle to help while in transport. The ambulance must be paid in advance before they start driving.
2. There is no guarantee when you reach a certain hospital that they will have any space for you and many patients have confirmed that they were turned away from their entrance or worse lay on the door waiting for medical attention. Some patients died while waiting outside the hospital.
3. After running around with the patient in the back seat, we landed at an ICU-only facility. They take only ICU cases, no other.
4. Admission, if granted, is contingent upon if you can pay upfront. No money, no admission. Some hospitals only take cash and you have to wait for the cashier to be on his seat because they take unannounced breaks for lunch and tea from their duties. Don't expect a receipt immediately.
5. All supplies like medicines, injections, diapers, needles, bandages, paper towels, syringes, etc everything must be supplied by the patient and his attendants. No supplies, no treatment! If the hospital tells you that your patient needs oxygen then you, not the hospital must get out in the open market and shop around for oxygen cylinders, ventilators, and oxygen concentrators.
6. If you can get the oxygen supplies your patient lives, otherwise goodbye. All the supplies (except oxygen) are available at the in-house chemist/druggist (pharmacist) on the ground floor- perhaps one of the relatives of the hospital managers. They need upfront cash before they release the merchandise. No customer has the right or audacity to question the price of any item. The bill is what it is and it must be paid before you leave the window.
7. Blood, urine analysis, and all diagnostic scans are outsourced to an outside pathology lab because the hospital has none of their own. For diagnostic scans, the patient has to leave his ward, find a center that is available and get the test result sent to the hospital to analyze and recommend a course of action.
8. The blood report. When the “blood boy” arrives on the floor the patient or their family member like me must be present at that time to pay him cash on the spot, otherwise no blood can be drawn. No blood sample means, no report and therefore no further treatment. They want cash, no card or electronic payment. I had to plead with him to take the sample on the promise that I will visit his lab and pay his dues before 4 pm that day when his cashier closes his books. He obliged and said Ok I will take his blood sample but remember, our pathologist will not start his work until money is received.
9. When the patient was asked to get a HRCT scan, we had to leave our bed, find four attendants (cash payments to all of them for helping out) who can lift my Dad, roll the wheelchair to the ground floor, (there is no elevator) put him into the back seat of our mini car and drive around to find a diagnostic center. After many calls and talking to three of them, we found one. The machine emits sound like a stone crusher. This center tells us to wait for 3 hours because they are overbooked. There is no attendant available to bring the patient into the building, so we had to find helpers to lift my Dad and carry him inside. Upfront cash please and then wait outside for your turn. After the scan, wait for the report in the next 24 hours. There is one remote radiologist and he is so busy that he is covering 20 different diagnostic centers.
10. The main treatment protocol for Covid in the initial stages is virus containment using 6 doses of Covifor by Gilead Sciences - brand name Remdesivir, the drug disapproved for COVID use all over the world except in India. This drug was under so much demand that profiteers were selling it for ten times its original price. Then the Govt took over its distribution. Here is the patient procedure to get it. You, and not the hospital, is responsible to obtain it so that they can give it to your patient. If you cannot get it, we have no treatment.
11. To get the drug, the ICU attendant asks me to bring him Aadhar card - Indian Federal photo ID of the patient and his attendant, that's me. He checks the blood report and CT scans jots down some figures then fills an application for Remidisir justifying to the Govt bureaucracy its need based on the figures in the reports. He asks me to go to a different location to pay for the drug. Why? Because this hospital is not authorized to obtain it from the Govt.
12. I drive to a different location and stand in line with hundreds of others. (Read this - People hire agents to stand in queue for Remdesivir). Queues for Remdesivir start early in the morning and close in a few hours. Hundreds line up from the previous night. Once your turn comes at the window your application form must be legible and a copy of your photo ID card dark enough for him to read else they will be rejected. Keep the exact payment ready. Sometimes they have no change to return and ask you to forego the balance so that the next in line can do his transaction.

Once I get the receipt and I drive back, bring the proof of payment to my location’s chemist. He will call a Govt inventory control number and ask to fetch the drug from this secured facility somewhere at the Covid command and control centre, which arrives after 60-90 minutes. Like an award, I hold the vial and rush in exultation to the ICU announcing and waving to the staff that I have got the injection.

Who will inject the drug ?

I was told to wait till somebody is available. An attendant saunters in after 10 minutes and asks me - Where is your patient? After a brief reminder and introduction, she unravels her drip-hanging routine. I watched in awe the intravenous infusion for 90 minutes, glancing at my WhatsApp messages titled Remdesivir Fails to Prevent Covid-19 Deaths in Huge Trial. Drug procurement and administration routine will repeat for the next 4 days.

1. Small town hospitals will not provide food or water to the patient. I must bring them from home. Once it is laid on the side table I have to wait till my patient comes out of the comatose stage so that I can drop some morsels into his mouth.  Before I leave, I have to plead with somebody to help my Dad eat some food. Next day when I checked, I found all his food was untouched. Why ?  Because nursing staff do not have time to feed patients. If he is thirsty he must make noise or wave to attract attention and let somebody help him sip a few drops from the flask. Later I fixed this exigency by finding an attendant who would gladly exchange his time for some out of pocket cash.
2. On the third day when I visited him bringing him some fresh food I noticed he was lying in his own feces and urine, unable to move. Upon demanding why no attendant helped him I was told that’s not part of their job. We are hospital people, not jamadars or low caste cleaners! (Read The precarious condition of hospital cleaning staff)
3. Their ward boy who did all the cleaning was busy and not available. The patient’s family must clean and do it themselves. I have to now find somebody who can do it in my absence and fix a cash payment for every cleaning. He requests me to pay him outside the premises because the whole ward is under camera surveillance. I gave him my personal mobile number, just in case he needs to contact me. One morning he did. ...“Your Dad is thirsty and asking for water. I helped him get water by buying a bottle of Bisleri so when you come add Rupees 40/- (CAD $0.66) to today's payment…”
4. The main doctor onboard has delegated the administration of treatment to junior ‘doctors’, paramedical staff, ward boys, and cleaning staff. Since everybody is covered in PPE nobody knows what their names are, let alone their designation and authority when they bark orders to bring them supplies. Many attendants by their language and conversation seemed like they were fresh from high school in their villages.
5. There is no customer service line. The main reception office doesn't take calls if you need to inquire and get a status report on your patients. There are no phone extensions in any room to talk to your patient from home. If you leave a mobile with your patient there is no guarantee you will find it the next day. Many patients and their family members confessed that their personal items like jewelry went missing when the patient was drugged and no family member was on the floor.
6. The Chief Doctor in his brief tour on the floor proclaims there is no treatment for Covid and all they do is to keep patients for observation of their vitals.
7. Once the oxygen saturation irreversibly slides and chest infection gets out of hand, they let the patient go home through a quick and convenient discharge, before they must give the sad news to their family members. After having squeezed all the hospitalization charges, they will ask their family members to either take the patient home or to a big hospital in a metropolis because they have done whatever they could, and since your patient is not improving you can take him home. A good way to let the patient die either at home or somewhere else because if the patient dies on their floor, it blemishes their record. At least three patients on a faltering oxygen supply, next to my Father’s bed, passed away one after another. I saw their obituary in the local newspaper the following week. Their beds were immediately occupied by new patients, with cash in hand, waiting in line at the admission clerk’s office.
8. Once the patient dies, you have to pick up the body without delay because they do not have any storage. Besides, other patients are waiting for their turn to occupy that same bed. Private ambulances, like vultures preying on dead bodies, took advantage of the situation and demanded ten times the usual charges to transfer the corpse to the nearest crematorium. Many indigent families carried their deceased on taxis or worse hand-driven garbage carts. In the crematorium, you must take a token and get in line because there is no available space to burn the bodies. Many, piled bodies on top of each other because it saved them time and money. News abound of families leaving their dead next to the banks of river Ganges. 

It was my first brush with the Indian hospital system and many have confirmed that the system is the same in big and small cities or even expensive corporate hospitals. 

How much I miss my Canada ! O Canada

In Canada, we take it for granted that each and every patient will receive first-class treatment irrespective of their ability to pay. They will be fed, nursed, and given all the necessary medicines without being asked, on their beds, to pay first or else get out.

I get to appreciate the Canada brand every time I shudder to think what happens if I have to go to the Indian ICU one more time. Let me pay my respects to what Canada gives me all the time. Thank you, Canada.

Amarjot Singh

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Author can be reached via email at [email protected]