NEW DELHI, India — Seema sits cross-legged on a filthy sheet of cardboard next to a crumbling concrete planter in the central square of Nehru Place, New Delhi's computer and electronics hub. Four years ago, at the age of about 14, she gave birth to a son on this very spot, without the aid of a kettle of boiling water or a clean blanket, much less anesthesia or a doctor. Four days ago, the same little boy, Rajesh, died here, on the same slab of pavement.

Suffering from pneumonia, Rajesh never saw a real doctor, even though his mother and the community of rag pickers who live here scraped together everything they had to collect 500 rupees ($12) to pay for treatment. Not knowing any better, Rajesh's family took him to an informal medical clinic on the outskirts of town — the only private medical care that they thought they could afford. The staff there gave them some medicine. But nobody on site had any medical qualifications, so Rajesh wheezed and coughed himself to death.

“I gave birth right here,” Seema said. “It was in winter. That's how Rajesh got sick in the first place. We took him to the doctor so many times. So many people's children I've seen die. They collect money from various places and go to the doctor, and the children still die.”

Seema's grief echoes across the country. According to a new report by Save the Children, nearly 2 million children under 5 die every year in India — one every 15 seconds — the highest number anywhere in the world. More than half die in the month after birth and 400,000 in their first 24 hours. Devastating poverty is the root cause. But the full story is even more grim.

India has swiftly gained a global reputation for excellence in health care thanks to the thriving business of “medical tourism.” But the patients jetting in from the U.K., the U.S. and other wealthy nations to take advantage of relatively low costs for planned surgeries like knee and hip replacements and cosmetic procedures have drawn attention away from the disastrous conditions at most hospitals — not to mention the total dearth of health care for hundreds of millions of Indians.

And medical tourism has a dark side: it has encouraged wealthy and influential Indians to forget about the crumbling and overburdened government-run health system, because they now believe they have access to the world's best care from private hospitals.

As a result, the Indian government spends only 0.9 percent of its gross domestic product on health care, ranking 171st out of 175 countries in public health spending, according to the World Health Organization. It relies on the private sector, which contributes another 4.3 percent of GDP, to make up the shortfall. So even though state-run hospitals like the All India Institute of Medical Sciences (AIIMS) — a renowned center that treats about 3.5 million patients a year for less than a dollar apiece — do their best to care for everybody, the rich and poor alike often turn to private clinics.

These private players, which receive tax breaks and purchase land from the government at subsidized rates, make much of the charitable work they perform for India's underprivileged. But a recent Delhi High Court judgment against Apollo Hospital and a subsequent health department investigation suggests that at least some of these claims may be exaggerated or even false.

In September, the Delhi High Court slammed Apollo for failing to live up to its commitment to provide free treatment for the poor in 40 percent of its outpatient and 33 percent of inpatient business in exchange for concessionary land rates, saying, “The hospital has made a complete mockery [of the agreement].” According to the All India Lawyers Union, which brought the suit against the hospital, the Delhi government granted Apollo 15 acres of land for the token price of one rupee and spent about $3.5 million in public funds on the construction of the facility.

“The entire purpose of giving them the public land was frustrated,” said Ashok Aggarwal, the lawyer who argued the case against the hospital.

According to a spokesperson for Apollo Hospitals, the corporation's charitable activities are significant — including the performance of more than 50,000 surgeries and other interventions for poor children suffering from heart disease — and the Delhi hospital in question averages about 60 patients admitted for free care every day. Apollo Delhi also operates a mobile clinic for the poor that has treated 26,000 patients over the past decade, the spokesperson added.

Apollo is by no means the only alleged violator, according to the Delhi government health department, though the hospital's $300 million parent company's fame in medical tourism makes it the most recognizable name of the bunch. A day or two after the judgment against Apollo, health department officials revealed that many of the 40-odd hospitals that were given government land at reduced rates were not utilizing the beds intended for providing free treatment for the poor. About 350 out of 500 beds intended for charity patients were empty. At least part of the problem is that poor people like Rajesh's parents don't know that these private hospitals are obligated to help them. But they may know the ground situation better than activists and writers.

“Even if knew they [private hospitals] were supposed to, do you really think they would let someone like me come through the door?” Rajesh's mother asks bitterly.

The privatization of health care has other dismal consequences, too.

Forty percent of the primary health centers are understaffed; India has fewer than one hospital bed per 1,000 people, compared with a world average of nearly four; and for huge swaths of the countryside medical treatment is simply not available.

At state-run hospitals, hundreds of patients line up in the emergency room to take advantage of free treatment, ensuring a long enough wait that desperately poor people like Rajesh's parents believe they're better off paying for fast service elsewhere — even from a quack.

Reports of stray dogs, monkeys and rats wandering through the wards are commonplace, and every so often local newspapers highlight something more disturbing, like a manhole burbling with waste water in the center of a patient's room.

Though the elite's faith in the much-feted private hospitals remains unshaken, the truth is that not even the wealthy can escape unscathed from the drastic gap between supply and demand. Just a few weeks before 4-year-old Rajesh died from untreated pneumonia, Col. Satyendra Nath Bhargava, 68, succumbed to organ failure after awaiting treatment for an apparent heart attack for five and a half hours in the emergency room of the Artemis Health Institute, a high-priced private hospital in the Delhi-satellite town of Gurgaon, Haryana, according to his son.

As a decorated veteran of India's 1962 war with China, he could have sought treatment in any number of army hospitals. But his wife, naturally, called an ambulance from the nearest facility. Once she got there, sometime in the middle of the night, the staff refused to administer any tests on her husband until she went home to collect 50,000 rupees in cash (about $1,000) for a deposit. After that, there was no doctor available. Only five and a half hours later, when one of the staff recognized the colonel's sister-in-law — herself a well-known medical doctor — did the hospital finally track down a physician.

By that time, it was too late.

“These hospitals, because they are big corporates, think that they can do whatever they want,” said Kanish Bhargava, the colonel's 36-year-old son. “I used to always say that private hospitals are very good, and that they look at you and take care of you [quickly]. But I'm sorry to say that they don't. It's a money-making racket.”

Editor's note: Dr. Hassan Tehrani, head of medical services at Artemis, has disputed the veracity of some of the facts reported here. A full explanation of the hospital's position will be
forthcoming here.

http://www.globalpost.com/dispatch/india/091013/the-dark-side-medical-tourism