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Health Data of Dumka and Birbhum from the Pratichi Report (Pratichi is the foundation Amartya Sen put up with his Nobel Prize money)

If the non-availability of medical treatment from the public health delivery system imposes a heavy economic burden on the suffering people and their families (as they have to depend upon the market to buy medical assistance), unethical and corrupt medical practices by different medical practitioners make things worse, As we have seen earlier in this section, the unqualified medical practitioners (quacks) who form the backbone of the health services, particularly in Dumka, operate without sufficient medical education. In almost all the study villages (and also in some other villages) the quacks were seen to c rry saline water bottles with them, which are used as the most common medicine for any sort of disease. The first thing they were seen to do was to administer saline water even before doing a physical check-up, let alone trying other modes of treatment. According to a Block PHC incharge in Dumka, "These illiterates without knowing the consequences of administering saline kill many patients. There is very little scope for using saline water in cases of malaria; rather, it generally proves counterproductive if administered during fever. The only motive behind such ill-practices is to squeeze as much money as possible from the poor ignorant patients."

Some of the quacks were also reported to have sexually abused female patients. In a Dumka village we were told: "\with one unmarried woman, the quack said he had forgotten to bring his stethoscope and fondled the breasts of the patient pretending to do a check-up. Not all villagers were as ignorant as this particular 'illiterate patient and some of the young men of the village beat him black and blue as punishment..."

Not only the quacks, there is evidence of severe medical abuse even by qualified private practitioners. Suna Hembram was suffering from general weakness. He visited a highly qualified medical practitioner at Dumka town who aside from government service and private medical practice owns a medicine shop, a pathological laboratory and a nursing home. After checking up the patient he prescribed three medicines (all in tablet and capsule form) and advised malaria Parasite test. Flis assistant (called a compounder) took him to the nursing home, administered a saline and then took him to the laboratory for a Malaria Parasite test and also for an X-ray! No paper or bill or receipt was given. When Hembram asked for the accounts, he was given a piece of scrap packaging paper from a medicine bottle charging Rs 900.

Hembram had only Rs 500 with him. His wife borrowed the rest from relative living at Karharbil on the outskirts of Dumka town and got her husband released.

Hembram, however, did not come round. After 15 days he saw a physician at

Deoghar, who is known to be sympathetic towards poor patients, who diagnosed that Hembram had low blood pressure! This time he had to spend only Rs 75, which included his bus fare.

While private practitioners are accused of medical abuse which they indulge in only to earn money, in the most unethical ways, government doctors were also frequently held responsible for negligence in treatrnent. A patient with a fractured leg was treated at the Dumka Sadar Hospital. He had to spend Rs. 800 for the treatment. But after the plaster was removed, his leg was found to have become deformed. The fractured bone had not joined properly. The government doctor told him that it was irreparable. Later, the patient visited ^ private doctor in Patna. He had to go through a surgical operation to repair the damaged leg, which claimed a sum of Rs. 15,000.

Cases of medical abuse in Birbhum too ranged from quacks to qualified medical practitioners, though to a lesser extent compared to Dumka'

Many of the quacks of Birbhum were seen to remove the foils of the medicines before gt ri"g them to the patients. Some people in the study area and some qualified doctors maintained that such practices Oy th. quacks) was to safeguard themselves from future legal complications (death caused by wrong medication etc.). Some of the quacks were also reported to have been using "magic treatment" or religious rituals (puja, manot, etc). One such quack told us that no foreign practices could be successful in India unless it was backed by Indian religious futh. "Viswase rnila1 uasta' tarke bahudar- it is faith that yields fruit, not reasoning". One quack started his allopathic practice when he was only a student of Class 8. He has a reported area of 10- 12 villages where he travels regularly. According to him his popularity had increased because of the "unique" practice of mixing allopathic medicine with religious rituals.

Another quack said that he uses a long range of antibiotics,"konl ekta to lagbei! (One of these will surely work!)" This he did, as he had to save the patient's life.

Many of the people who seek services from the public or private qualified practitioners also reportedly fall prey to medical abuses. After consulting with a government doctor in his private chamber a pregnant woman was admitted to a sub-divisional hospital of Birbhum for childbirth. At the time of delivery neither a doctor nor a nurse assisted her. She was released after three days (and during her stay in the hospital she remained almost unattended). In the evening of the day of release from the hospital she started shivering and was taken back to the private clinic of the said doctor, where she was told that there were traces of placenta in the uterus.

Dr Prabir Chatterjee

Jharkhandi.com/prabirchatterjee