Tuesday, May 26, 2009

a place by the sea

Bernada is the name of a nearly 100 year old clinic by the beach, in this city.

A quaint little place, still run pretty much the same way as it was when first established by some missionary with a sense of beauty.

I say it, because the place is beautiful.

An ancient building, and an even more ancient sister in charge. Neat white half-curtains on wooden windowpanes. Everything in its place.

A lone mangotree.

A sense of permanence.

The duty doctor's room having an old table and chair, bed and almirah.

Too bad the bed is not a four-pillar complete with mosquito nets, completing the colonial set-up. Not that a mosquito net was necessary, with gentle breeze from the sea flowing through the building at all times there are no mosquitoes to speak of.

As of now, the duty doctor's room has a regulation iron frame hospital bed. There are other indications too, of cracks in this otherwise picture-perfect place. Like the attached bathroom with missing toilet cover. I am sure Mr Romantic Missionary that started the place would never have stood it.

Perhaps, all is not quite well about this picture-perfect place.

Bernada is a place on the decline. As sad as it is true. Sadder still that it doesn't have to be. As I said, its still run pretty much the same way as when it was first established. A Nursing home giving basic healthcare. There must've been a time, before the city grew upon itself and extended right upto the beach, before the airport and not far-away tourist village were established, that it was the highlight of the area populated mostly by christian fisherfolk. Back then, the place must have been indispensable.

That is not the case today. Or Atleast that's what most people seem to think anyway. There being no dearth of fanciful multi-speciality hospitals in the city, they say the day of the nursing home, manned by a single doctor or at most a handful of non-specialists, is over. That they'd rather pay extra and go to one of those places that you couldn't at first sight differentiate from a star hotel lobby.

Now, I have nothing against multi-speciality hospitals. Or star hotels for that matter. And I honestly do wish everyone had the money and opportunity to get the level of healthcare that they deserved.

But there is still a strong case in favour of your neighbourhood nursing home. Your friendly neighbourhood doctor you would want to visit not just to talk about your ailments, but also about your daughter's marriage. Its About a whole value system that is being withered down by the onslaught of corporate culture (or the lack of it)

I have nothing against corporate culture either.

Its just that the relationship between doctor and patient is a sacrosanct one, and the best part of it is irrevocably lost when you try to manage it along the lines of a consultant-client contract.

I know how that one sounds. Repetitive and Pedagogous.

But that doesn't make it untrue.

Emotional issues apart, there is a really strong case in favour of having small nursing homes alongside large multi-speciality hospitals.

I say alongside, not instead of.

The issue is not just one of spiralling costs of healthcare.

It is also about local responsibility.

About inclusive access to healthcare.

About not losing your identity, Anonymity being the hallmark of what is known as Evidence Based Medicine or simple EBM.

They figured that out in the west a while ago: That corporate logics dont work that well in healthcare. They are going back to small single-doctor clinics in the UK right now. The Americans know it too, but since its bad business they would rather not talk about it. One look at comparative figures of UK and US health statistics will tell you the rest of the story. Guess who is better off - the Brits or the Americans?

I had ample time to think of all this while I worked night shift at Barnada Nursing Home recently.

For there were not very many patients that came to the hospital. I wonder if they had been forewarned about a certain doctor being on duty on a certain date. I wish that had been the case.

But I know that it was not. That Barnada, alongwith many other small clinics like it, is facing closure.

Patients dont want to go there. Doctors dont want to work there. Unable to hire full-time doctors, small-time nursing homes time and again fall upon a pool of just-graduate (and sometimes not yet graduated) doctors to mann their services.

That's where the person who wrote this comes from.

I once read while in school, many years ago, that Home is the place, where, when you have to go, They have to take you in. I did not understand one bit of it, but for some reason the words stuck in my memory. It was only much later, when I had understood a little more about the tortuous ways of love in the world, that I learnt what whole turbulent world was hidden beneath them.

There's still very much a case in favour of your neighbourhood nursing home indeed.

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