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India health: Spit and polish?

At India's most renowned hospital spitting is ubiquitous and, potentially, dangerous.

While private institutes like Apollo and Escorts have earned the lion's share of headlines for attracting medical tourists from Britain, the United States and other developed countries, a typical 700-bed private hospital in Delhi treats only around 200,000 people a year, at fees that start around $25 a day for inpatients — nearly half the monthly salary of a lower middle class worker. Government-run AIIMS, with around 2,000 beds, treats 3.5 million people a year, charging only about $1 a day for in-patients and providing emergency care for free.

Even with government funding of around $100 million a year, budgets are strained. The student doctors who make up the bulk of the medical staff here earn only about $300 a month. The orderlies and cleaning crew are routinely asked to put in unpaid overtime to keep the place running. And the constant flow of nearly 10,000 people per day make the outdated building materials — which include rough concrete, cracked tile floors and windows that don't seal – almost impossible to keep clean.

“See, we are in India,” says one hospital employee, who asked not to be named. “We are Indians. We have our local standards. This is a public hospital, so the public will do what the public will do. We have to deal with it.”

To be fair to its beleaguered sanitation staff, though the ramshackle premises would come as a shock to a visitor from America or Europe, AIIMS deserves some credit for cleanliness. Inside the outpatient department, the floors show signs of recent mopping, and most corners are free of the blood red spit stains — the hallmark of the popularity of the betel nut-based stimulant known as paan — that are ubiquitous in most government buildings. One can only occasionally detect the faint scent of disinfectant. But that's leaps and bounds ahead of other Delhi institutions, like Lok Nayak Hospital, where the mysterious stink of seeping sewage is pervasive.

According to the hospital staff member who spoke to GlobalPost, lack of manpower is a bigger challenge than spitting. Showing us a contract for outsourcing the cleaning of toilets to a private firm for around $80,000, the worker laments the denial of a routine request for increasing the cleaning staff by a measly six people.

“We (the cleaning staff) have no authority, and no channel for promotions,” the employee says. “If a VIP is coming, we're called for duty in the middle of the night, with no pay for overtime. They want everything done right. But they don't do anything for us.”

And it's the poor people waiting to be shown off the premises for the night by the hospital guards who have to bear the brunt.

“Sure, people spit,” says 32-year-old Bhagwan, who has been making a seven-hour journey to bring his anemic wife here for treatment for the past three years. “People even take a crap if they have to. It's only because of that they lock us out at night.”