The church and the Christian community in India have always been justly conscious and proud of its involvement in two sectors historically- education and health care. This involvement has been an interesting one and from a time where the church run health care meant charity and charitable institutions, today many church run institutions are involved in a variety of initiatives –including an adoption of the rights based approach which really represents a paradigm shift. In India, and other developing nations, the presence in the field of health care of the Church and NGOs needs to be evaluated and new strategies for better effectiveness need to be adapted especially as we live in times where even the legitimate concern of the church are looked up by many in our nation with unease and suspicion.
If the Christian institutions and churches have earned recognition for their contributions to society in past days, it was because they were relevant to their times and the health care needs of those days. If we want to retain that appreciation or regain that stature, we need to rediscover and reclaim that position by doing three things and all at the same time: Be Advocates for the poor and the marginalized as the scriptures instruct us to do, be the best and most effective in all that we do and be the Champions of innovation and change constantly in all our institutions. It is no longer possible or right to breathe and live on the basis of past glory, no matter how noble the foundations might have been.
The Church which historically provided health care through its institutions is today saying that health care is a basic right that the state should provide and to which the citizens have a right. While institutions have not been abandoned or closed down and still provide a significant service, this approach of demanding from Caesar what he should rightfully provide because of the taxes he collects is a bold initiative for a minority community and its institutions to taken and should be applauded. Such initiatives should in fact expand in their scope. Now what does all this mean?
The flagship program in health of the government since 2005 has been the National Rural Health Mission. The purpose of this mission among other things is to strengthen the primary health centers (PHCs) and sub-centers and create a network of rural hospitals. The direction that NRHM has taken has led to the increased privatization of health care services in the country. Now while it is a separate discussion as to whether privatization of health care is good or bad, can the church with its numerous institutions, clinics and committed manpower step in to provide low cost and ethical health care. If that could be done, it would not only mean that the church’s own resources are freed up for other things, but also a huge contribution to society in general where the general complaint across states is that the government run facilities are sloth or corrupt, if not both.
However despite the growing reality of public private partnerships, participation of Christian institutions is in this is still a largely untapped opportunity. Apart from this, can the church with other like minded and committed organizations act as a watchdog to ensure that the resources allocated for the running for the program are actually being used effectively and usefully. The church with its numerous dioceses parishes and mission stations has a country wide presence which is an unparalled advantage.
Indian systems of medicine is again one of those areas where attention would be helpful. The Indian Systems of Medicine & Homoeopathy continue to be widely used due to their accessibility, efficacy and affordability. The Indian medicine system is also embedded in the beliefs of a wide section of the public and continues to be an integral and important part of their lives and for some, it is also a way of life. Complementary and Alternative Medicine or Traditional Medicine is rapidly growing worldwide. In India also, there is resurgence of interest in Indian Systems of Medicine. People are becoming concerned about the adverse effects of chemical based drugs and the escalating costs of conventional health care. Longer life expectancy and life style related problems have brought with them an increased risk of developing chronic, debilitating diseases such as heart disease, cancer, diabetes and mental disorders.
Although new treatments and technologies for dealing with them are plentiful, nonetheless more and more patients are now looking for simpler, gentler therapies for improving the quality of life and avoiding problems of toxicity. Ayurveda, Homoeopathy, Siddha, Unani, Yoga and Naturopathy offer a wide range of preventive, promotive and curative treatments that are both cost effective and efficacious. There is a need for ending the long neglect of these systems because it is the various indigenous systems of medicine are the ones that are typically patronized by the poor being affordable and rooted in the country’s folk traditions. Even the WHO Charter on traditional medicine encourages health systems to immediately address this neglect of this vast body of knowledge.
In the neglect of indigenous medicine, Christian institutions are on the same side as any one else in the country. Since the majority of Christian doctors and nurses are trained in Western medicine, the hospitals and clinics they run are also based on the Western tradition. The unfortunate result was the marginalizing the Indian system of medicine, that has been practiced in India for thousands of years and has benefited millions of people over the centuries. In fact a lasting contribution to the promotion of Indian Systems of Medicine by the church would be to set up an institution of the stature of CMC Vellore or St. John’s, Bangalore, where training is provided on alternate systems of medicine.
At the turn of the last century, the church run hospitals and clinics had a virtual monopoly on providing health services outside the big cities. Government institutions and hospitals tended to be in the cities, the whole chain of primary health care institutions were non existent and so what little was there was provided by the church. Today, that is no longer the case. Options have emerged and even if many of the options that exist today are hardly inspired by philanthropy, they nevertheless exist and people use them – even the poor use them even if they can’t afford it.
But in a situation that is no longer monopolistic from a business point of view, and operating in a climate that is no favorable from a social and political point of view, our institutions not only have to survive and thrive but be the best. But what is best? Many corporate hospitals have emerged today; that technologically speaking has every thing to offer provided if you have the money. And increasingly the choice is becoming between costly corporate hospitals (not necessarily ethically managed though!) and ill equipped badly run government clinics and hospitals.
The genuinely non profit sector is gradually disappearing and this space is getting vacated. The social costs are damning. P.Sainath in November 2007 cites a study done for the WHO in six Indian States found that 16 per cent of households it looked at were pushed below the poverty line by heavy medical costs. Nearly 10,000 families from lower income groups were covered by the survey for the years 2002-05. Some 12 per cent had to sell their assets to meet health expenses. Over 43 per cent had to resort to loans for the same reasons. I hope that a day will not come when patients have to sell of home and hearth to settle bills in a Christian hospital to avail of the “best” health care available.
The late Pope John Paul II, in his Apostolic Letter, Ecclesia in Asia, wrote: “Following in the steps of Jesus Christ who had compassion for all and cured “all kinds of disease and illness” (Mt 9:35), the Church in Asia is committed to becoming still more involved in the care of the sick, since this is a vital part of her mission of offering the saving grace of Christ to the whole person. Like the Good Samaritan of the parable (cf. Lk 10:29-37), the Church wants to care for the sick and disabled in concrete ways, especially where people are deprived of elementary medical care as a result of poverty and marginalization”.
What people expect from the church and the church run institutions is not necessarily the technological cutting edge but acceptable and appropriate standards of care that are ethical, affordable and administered with compassion, grace and prayer and that in fact can become a protocol for others to emulate. May be for this a business model needs to be evolved that combines business acumen, human sensitivity and ethical protocols. In that sense, while the church’s ministry, much as the Lord Jesus’ example and reminder through the story of the Good Samaritan remains always the same, the ministry of the Good Samaritan himself trying to be a neighbor to his people has evolved over the centuries and must continue to do so.