Where are the face-masks, gloves, and hand-sanitisers – forget boots and body-suits – for city cleaners and garbage collectors, those who in the current Covid-19 ‘lockdown’ are still working, to keep Goa free of dust and dirt? Where is the water and soap to wash up after work? Nowhere to be seen, and not a word mentioned either by our Chief Minister or Health Minister, both pontificating about how the state government is committed to protecting people’s lives. But which people? Everybody, or just some?
India’s health care system is commonly held to be in a shambles. We always hear about how the government hardly spends anything of the national GDP on health, less than many other Asian countries; how even that miniscule percentage is always decreasing, so much so that much poorer nations, including Bangladesh, Nepal, Ghana, and Liberia, spend per capita more than India.
But the truth is that our health care system is not in a shambles at all. What it is – or what it is intended to be, as in the case of education and all other public facilities – is a good (or pure) brahmanical system of quality medical care (and medical profits) for the dominant castes/classes, and next to nothing for everyone else. This has been achieved through insufficient, overcrowded, poorly-funded, poorly-maintained, and poorly-staffed government facilities on the one side, and, on the other, a vast network of privatised profit-driven health care, not always great in quality but from zero to seven-star in luxury, for the benefit of dominant-caste patients (who can also avail of medical insurance – i.e. public money – to help them foot the bloated bills), and now increasingly for rich foreigners. The private system focusses on lifestyle and geriatric diseases, and generates billions of dollars in profits from medical tourism, while the public includes everything and, though often accused – justifiably – of every possible failing, still manages to make a huge difference for millions of Indians every day. But its many inadequacies mean the poor have also been forced into the private sector, at that end of the spectrum which is unregulated and poorest-quality.
This is how things have been in India for at least half a century now. In Goa, there is still a wide reliance on the government set-up, but things are changing, with the public facilities going south, the private sector booming, and the government encouraging the latter, now via new insurance schemes. An interesting point to note is that it is the same medical establishment – doctors, ministers, and bureaucrats, mostly privileged-caste – who preside over both worlds. And the result is a medical caste system where background, connections, and money decide the kind of medical care you get.
But many of us privileged sorts like to ignore the savageness of this reality. E.g. some Indian liberals on social media seemed shocked to hear that Italy – battered by Covid-19 – may soon be choosing which patients to provide intensive care to; in other words, choosing who will live and who might not. What a horrifying situation to have reached, surely? Except that, as doctors working in India have pointed out (Gopichandran et al, 15/3/20), it happens here too, every day. Every absolutely normal day, individual doctors in our overstretched public health system – especially in rural India – decide on whom to expend scarce resources and who to turn away. That’s normal.
Could that be why India is not testing enough in the current Covid-19 pandemic? There has been criticism of the limited testing being done here, of only sick people who have been abroad or those in touch with them. But, besides the fact that there aren’t enough testing facilities around (and none in Goa), can we deal with the numbers likely to turn out sick? Because infectious diseases are the problem of government hospitals. Already some of those who have been hospitalised for Covid-19 – belonging to the foreign-travelling castes – have tried to run away, apparently because of the hospital environment, like overflowing toilets and general squalor. But these are normal conditions in hospitals for the poor. Just like manual scavenging remains a job in India, despite being officially banned. That’s the caste system for you.
But what is the government to do with this new disease which does not recognise caste? Best to pretend that we have no problem.
So, limited tests, but strong government directives on ‘social distancing’ and hygiene, focussed as usual on those with formal jobs, homes, and water supply. Critics have pointed out that social distancing can become a bigger killer than the disease when most people are daily-wage earners; staying at home means eating nothing. The Goa government has not shown any interest in solving this life-and-death problem, nor in making sure everyone has enough water and soap to maintain hygiene. Nor, as pointed out earlier, has it provided basic protection to high-risk employees like cleaners and garbage collectors.
Surely, these ministers know that, by putting these workers at risk, they are endangering even themselves? Or are they just congenitally incapable of improving things for people of bahujan castes? In Pune, with confirmed Covid-19 cases, but, again, no basic protection for municipal cleaners, the latter have declared their intention to strike work unless the situation is rectified. Perhaps this is the only solution.
(Amita Kanekar is an architectural historian and novelist.)
