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India Offers Both Best, Worst of Health Care

Most of India's billion-plus people struggle with a public health care system that is overburdened in cities and virtually nonexistent in villages. On the other hand, private health care is booming, and the country's state-of-the art hospitals and highly skilled doctors even attract patients from countries where health care costs are much higher. The challenge before India is to make such top quality care accessible for the majority of its people.

When Pardip Singh's elder brother fell ill with a severe nerve ailment in a remote village in the eastern state of Bihar, he brought him all the way to New Delhi's All India Institute of Medical Sciences - the country's premier government-run hospital.

Singh had little choice. There were no health centers or doctors near his village who could even diagnose his brother's condition. At the New Delhi hospital, some of the country's best doctors attend to his brother. Twenty-eight-year-old Singh's worries should have ended - but they have just begun.

Singh says he has given up his job as a security guard to stand in long lines with his brother at the hospital. The treatment is free, but to pay for the tests, he has borrowed 350 dollars at a crippling interest of nearly 50 percent a year.

Like Singh, thousands of people flock everyday to big public hospitals in Delhi and other cities for treatment.

But in these overcrowded hospitals, they must first battle serpentine lines to see specialists, wait months to undergo tests and surgeries, and spend more than they can afford for board and lodging. Many sick people never gather the resources needed to make the journey and tens of thousands of others borrow money or sell assets to cover expenses.

The head of All India Institute's cardiology department, Srinath Reddy, says one of the primary problems confronting the country is that two-thirds of its billion plus people live in villages - but most hospitals are in big cities.

"We have maldistribution," Reddy explained. " The rural areas and some of the underdeveloped states do not have adequate medical facilities. It is not so much acute lack of vaccines or hospital beds. But most of the beds are in urban areas whereas most of the people are in rural areas, so that is where the problem is."

It is not just advanced care that poses a problem. Even good basic care is inaccessible to the vast majority of people. Thousands of primary medical centers exist, but they are perpetually short of personnel and medicines.

The government, led by the Congress Party, has promised to increase health care services for the rural areas and the poor by appointing community health workers, and implementing a national insurance program - but little has been done so far to meet those goals.

The lack of an effective public health system has led to a booming private system, which takes care of three-quarters of the country's needs.

But the system is unregulated, and poor people are often forced to turn to medical practitioners who are little more than quacks.

Dr. Reddy at the All India Institute is a member of a new private initiative called the Public Health Foundation, which wants to train thousands of public health professionals to meet the country's vast needs.

"There are no standard guidelines (for) treatment which are universally disseminated and adopted for practice by primary care physicians, there are no quality checks," he said. " And therefore both malpractice which is intentional as well as inadequate medical treatment, these are problems that plague the private sector health care delivery."

The scene is radically different for those who can pay for top-of-the-line private services.

India's million plus doctors include specialists on par with the best in the world.

These doctors staff state-of-the-art facilities that not only cater to middle class Indians but also attract patients from other countries.

That has encouraged a budding medical tourism industry - drawing foreign patients to India for world class treatment at relatively low cost.

New Delhi's Apollo Hospital is at the forefront of this emerging business. Last year it treated 12,000 patients from across the globe - neighboring Bangladesh and Pakistan, to Africa and even developed countries such as the United States, Canada and Britain.

Some people come for knee replacements and heart surgeries for which they may have to wait for months in their home countries, others seek cosmetic procedures that are five to 10 times cheaper in India than in developed countries.

Apollo Hospital's marketing head, Anil Maini, says such hospitals are "centers of excellence". He says once the hospital door is shut, overseas patients never glimpse the urban slums, overcrowding and other problems in India that might erode their confidence in seeking treatment in a developing country.

"Within the four walls of the hospital, we pick him up from the airport and bring him in, he is totally cocooned in the hospital and not exposed to any Third World bane as we say," Maini said.

Fernanda Wagland from Britain was traveling in India with her husband when he was hit by a stomach infection.

She brought him to Apollo Hospital and describes the experience as "pleasant." She may even consider seeking treatment here in the future.

"In England, we would be in the kind of multiple (bed) ward, a bit more hectic, so we are getting more exclusive treatment here. If you really wanted something special done with more care and one-to-one treatment, perhaps one could consider coming here," she said.

The challenge before the country now is to put such high quality services within reach of the poor. Doctors say there is little time to lose - millions in the country suffer from infectious diseases such as tuberculosis and other killers such as AIDS, and lifestyle diseases such as diabetes and heart problems are emerging on a massive scale in rapidly growing cities.