( By Radhika Ramasubban, Bhanwar Singh & Nigel Crook )

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Roopa At The OPD

Understanding The Medical Services In The City

Rohit had recently migrated to Bombay with his wife and five year old child from a village on the outskirts of Nadiad town. He had an ITI diploma and had found a job in an engineering workshop in Kandivali. Through his sisterís husband who lived with their family in the Approach Road Chawls in Mahalaxmi, Rohit had managed to get a hut on rent in the same locality.

Within their seven months stay in Bombay the child had fallen sick with cold and fever several times and money was being regularly spent on taking him to the doctor. Between paying the rent, commuting to work and paying for the doctor, finding money for food was becoming a problem and when Raksha Bandhan came along Rohit had no savings to buy a present for his sister. He was depressed. He had already borrowed Rs. 100/- from Hasmukh another person from Nadiad who lived close by, and when Roopa his wife interrupted his thoughts by mentioning that the baby had again developed a high fever Rohit exploded, "What kind of city have we come to ! I work like a bullock and yet there is never any money left for anything. Were we not coming down with the odd illness in Nadiad ? There was money enough for food and we were never in debt."

"Nadiad was better than this, " agreed Roopa. "We lived close to the Primary Health Centre and the compounder was our relation. He brought us free medicines and the doctor too was so nice. Here we have to pay for everything and doctor does not care. " His shoulders drooping, Rohit left to see if he could borrow another Rs. 25/- from Hasmukh.

He ran into Rathode who lived two houses away. Rathode worked as a typist with a lawyer and lived with aged mother and younger sister, Anupama, who had passed Std. X and was also learning to type.

"Why do you look so depressed ?" he asked. " I need money to take the child to the doctor. Have you seen Hasmukh ? Heís my bank !" Rohit tried to joke feebly. "Who is your doctor ?" asked Hathode. "In any case, why do you go to a private doctor. WE always use the municipal hospital. My mother is often sick and my sister takes her to Nair Hospital. Why donít you go there too ?"

Lecture I


  1. Try to follow through the symptoms you feel every time you are sickening and keep a record of them.

  2. Try to explain your problem clearly to the doctor when you visit him / her in the hospital or in the private dispensary. This will train you to say all you want to within the short time that the doctor is willing to give to you. It will also encourage the doctor to be more responsive when he /she realises that you have come properly prepared.

  3. Do not be overpowered by the waiting crowd or the doctorís impersonality. If you have any doubts or want any information ask. It is your right.

  4. Find out what medicines are being given to you when you are given packets of pills or mixtures, and ask for the names to be noted on your case paper. Doctors often give capsules wrapped in little sheets of paper where no names are written. Writing this names and potency will help you to inform any other doctor you might go to in Bombay or anywhere else later, whether for the same complaint or for any other . This is particularly important in the case of long duration courses as for leprosy or TB. Allergies to powerful medicines like penicillin must be recorded. Every time you get a reaction to strong medicines and visit the doctor, take your case paper with you so that the doctor can identify which medicine you are reacting to and can record it. He will also note down the new medicine he is prescribing. This way, if you keep all the information with you it will not matter if the doctor is unfamiliar, as the record is there for anyone to see.

  5. Every time you are prescribed medicines ask for the dosage and timing to be written down and for how many days each medicine is to be taken. Find out what are the possible side effects --- which ones are normal and which ones mean going back to the doctor.

  6. If you are a habitual drinker or smoker or are on intoxicating drugs, or if you are pregnant or nursing, tell it to the doctor.

"My wife feels very difficult about going to a hospital all by herself and I am free only in the evenings," replied Rohit.

"But itís worth making a little effort for something thatís cheaper. Iíll tell Anupama to take your wife with her. In fact they are going this afternoon." With this assurance Rohit returned home. Anupama did all the paper work for Roopa at the hospital and Roopa returned home pleased that she had hardly spent anything. She only had to buy a bottle of crocin syrup. The next time the baby was sick Roopa went to Anupama.

"Will you come with me today ?" she asked brightly. "Sorry, Roopa, I am practicising for my typing exam. Why donít you go by yourself. You know the way by now, " replied Anupama.

That evening Roopa suggested that Rohit take the next morning off from work to go with her to Nair Hospital . "Iíll lose my dayís pay." protested Rohit. "Why canít you be on your own. "

When Roopa went to the Hospital with the baby the next morning she couldnít remember what to do. There seemed to be so many counters and when she was asked for her case paper she realised that it was the little piece of paper from last time which she had thrown away. When it was finally her turn, she found a different doctor from the last time.

Lecture II


  1. In the long run, it is much more economical to spend scarce money on staying healthy through nutritious food and keeping our immediate environment clean. By trying to understand our bodies and the way in which wastes and air pollution cause frequent illnesses, we can also avoid rushing to the doctor for every small problem. By going to municipal hospitals whenever we can and, particularly for vaccinations for our babies and children, we can keep ourselves free of disease somewhat economically.

  2. But sometimes we have to go to doctors and have to take medicines even from public hospitals. And these medicines are costly. It is important to tell the doctor how much you can afford to spend on medicines. If the list is long ask him / her to tell you which are the essential ones, ask for the names of at least two other alternatives as the particular medicine might be out of stock and you might not be able to go back for another consultation. Donít decide on your own which medicines to take and which ones to drop.

  3. If you are suffering from chronic disease like TB, or leprosy , try to find out if there is a government / municipal hospital or voluntary agency close to you which provides free treatment, as the course is very long and other very expensive.

  4. Every time there is a serious sickness in the family it is a trying time. Visiting doctors, buying medicines, buying vitamin supplements, buying adequate food to help absorb the medicines and build up the bodyís defences ... all require raising money.

  5. It is important that this is done promptly so that the sick person gets well quickly and definitely. We raise money willingly for social occasions like ceremonies or for religious festivals.

  6. Sickness is as important to tackle promptly. Otherwise, the chain of ill health will go on and on.

"What is the matter with the child ?" asked the doctor.

"But where is the other doctor who was here the last time ? She knew. You see ... " " Listen, forget about who you consulted last time. You had better hurry up and tell me what has happened to the child. " The doctor examined the child. " There is no need for medicines. It is an allergic cough which will go off on its own. Donít give him anything cold. " And the next patient was called in.

Roopa was upset. What rude behaviour ! Not even a proper exclamation ! And no medicines on the top of it all ! " You can make up your mind once and for all. Either you come with me to this free hospital tomorrow and talk to the doctor as he is not interested in listening to me, or I go back to the private doctor, " she told Rohit that evening.

Rohit had got his salary that day. He weakened a little. Perhaps they could go to the private doctor after all. But he recalled what Hathode had said ... " you cannot be spending your meagre earnings in visits to private doctors " ; and said to his wife, " Iíll come with you Roopa tomorrow. Could be you will manage on your own after that ."

This time Roopa remembered to carry the previous dayís case paper and to her delight saw the nice doctor of the first visit.

"You remember me, doctor ? I came here again yesterday and found another doctor ... "

The doctor looked at her blankly ; there was no sign of recognition. Finishing her examination of the child, she quickly made an entry on the case paper, repeated what the other doctor had said and called for the next patient. Roopa felt hut. But it did not seem so bad today ; at least Rohit was with her and they didnít have to go to so many counters since they had remembered to bring their earlier case paper. And Rohit seemed to believe the doctor that the child would be all right without any medicine in a matter of days.

That evening Rohit visited Hatode. " How did Roopa manage that day ?" asked Anupama, smiling. "You see, Roopa is used to Nadiad where she knew the people around her well --- the doctor, the compounder ---- so she gets upset in an impersonal environment. And when people are rude, she does not know how to react, " said Rohit apologetically. " The private doctor whom we have been going to here atleast recognises us. In that hospital it was so crowded and everybody was being hurried along so much . One didnít know what was happening. Nobody seemed to care. "

Anupama listened to him thoughtfully. "Rohitbhai, it is true that the public services should be much better than what they are .. more doctors and other staff so that they can attend to all the people who come for treatment efficiently and more politely ; better facilities like more cheerful waiting rooms where we have to wait in long queues ; better organisation so that case papers can be properly prepared and patients can understand things better. People who canít afford to go to expensive private doctors and for whom the government and municipality run these services, must get a better deal. But if you faced rudeness the other day it wasnít directed at your specially. It is the general atmosphere of the place. But there are certain things we can do to get more out of these public health services. The first is the case paper. It is very important to preserve this carefully for each member of the family, and to carry it with you each time you visit the hospital. It is like a record of what illness you have had and what medicines you have swallowed, like your ration card which says on what days you took your wheat or kerosene quota. If you always remember to take your case paper it will not matter who the doctor is as they will know from the paper about your health history. The second very important thing is that we must begin to try and understand out bodies better and our ailments better and when we donít understand we must not be afraid to ask the doctor for information howsoever busy the might look. It is our right. The doctor in the municipal hospital is not doing us a favour. The government or municipality pays for all these services because it is the duty of Government to protect the health of its citizens, especially those who are poor. You pay money to the private doctor.

Tell me, do you ask him questions and does he explain what is wrong with your health and what are the medicines he is giving you ?"

"Youí are right. He doesnít say much, either. We just swallow his medicines on faith. And we have to wait in his crowded dispensary too, even if it is not as bad as the municipal hospital. " replied Rohit seriously.

Hathode looked at his sister, surprised. "Where did you pick up all this understanding ? I thought my little sister was barely out of school and you are almost talking like a teacher !"

Anupama blushed and gave a delighted laugh. " There is a voluntary organisation which works in the locality where I go to take my typing lessons," she said. "Twice a week they run a balwadi, teach some sewing to the mothers and explain things about childrenís health and what one can do on oneís own. Since I finish my lessons a little early I Ďhave been down to the balwadi a few times. I help with the balwadi, but also find that I am learning a lot thatís new to me. They have been saying how important it is for women to know more about health, to take initiative without being dependent on their men folk. They have talking about projects where women can become members of banks which give money for building huts in the womanís own name. And so many other things..."

Lecture III


  1. Modern medicines have been able to save the lives of the infants and children from fatal diseases carried by germs through water, food and air. Modern medicines can also effectively cure adult diseases which are otherwise cripping or fatal such as TB, leprosy, and also sexually transmitted diseases. It is also possible with modern medicines to help cure other serious water-borne diseases like typhoid.

  2. But for most other ailments very few medicines are required. In fact, of the 30,000 drugs presently available in this country only about 100 are necessary and only about 20 are really essential.

  3. This means that most of the medicines in the market today are unnecessary and many of them are positively harmful.

  4. Medicines are produced by companies which make huge profits selling them. Since most companies are producing by and large the same medicines, they give them different names, colours and shapes in order to make them look different. Since each company wants its medicines to be sold, medicines are put in different shaped bottles and bright coloured packets and advertised attractively on TV and hoardings. Companies also send their representatives to all doctors with free samples of their medicines to persuade them to prescribe their medicines only. This is now ordinary people get totally confused by new and different looking medicines each time and become afraid to ask what these are and what they are for. Many medicines are also produced in the form of injections which, too, are often unnecessary and can often also be harmful.

  5. Injections are unnecessary except in emergency cases. Do not ask for them for a cure.

  6. The strong ones among the medicines often interact with other factors like smoking, alcohol intake, malnutrition, chemicals entering through the skin or into th lungs from conditions at the workplace. These interactions produce symptoms which require a good doctor to understand.

  7. A good doctor is one who prescribes as few medicines and injections as possible. A good doctor is one who prescribe as few vitamin supplements as possible. A good doctor is one who explains how the money can be better spent on buying nutritious food and how to prevent future illness.

"Itís going to be difficult for me to find an equally clever husband for you!" Hathode joked. "Youíll get to know too much if you keep going to this balwadi; itíll make us men look like fools!"

"It will be a lucky man who gets a wife like her. And lucky children who can get a mother who is so modern.... Why donít you take Roopa with you to the balwadi," suggested Rohit.

"Certainly, if sheíd like to come along. In fact there is going to be someone giving four lectures on health at the balwadi for the next four Wednesdays. We could leave the child with my mother for those days," said Anupama enthusiastically.

Roopa these days seemed to be talking all the time about all that she had been heard at the balwadi. Bombay didnít seem such a strange place after all. Nor were sickness, doctors and medicines such frightening things. One needed to know how to understand and cope with them--- that was what was important. She met other women at the balwadi and they talked among themselves about other things. She found herself talking to her neighbours and urging them to come along too. Rohit was pleased to see the transformation in his wife. The next Wednesday she announced to Rohit, "Today we are going to learn about medicines."

"Your compounder relative will then have to give up his job to you, if we go back to Nadiad," laughed Rohit.

Lecture IV


  1. You can take responsibility for your own health. Start by finding out about how your body and the environment around you work.

  2. Discuss with your doctor your ailment and the treatment prescribed when you visit.

  3. Discuss with each other, with your school going children who study some of this in their text books, with school teachers and paramedical workers.

  4. Watch out for hoardings and TV spots on how you can prevent ill health and where you can go to for health care from public services.

  5. Find out if there is a voluntary agency in your area which deals with health, education and related aspects. Interest shown by people can help these agencies to work better. Many voluntary agencies deal with specific diseases like leprosy. Many hospitals also provide free services in the community.

  6. When you are taking your baby for its immunisation go to a place where the vaccine stocks are fresh ; this is preferably a public hospital. Make sure to buy a disposal syringe for the injection;

  7. Keep the record of the immunization schedule for both primary and booster doses.

  8. In most cases injections are not necessary (tablets can do the job better ). But if you must take an injection, make sure to buy a disposal syringe to hand to the doctor. There is no need to feel ashamed or defensive. Unsterile needles are a great danger. It is better to be safe.

  9. Find out and keep a record of your blood group and that of each member of your family.

    This will help if you ever need extra blood as in the case of an accident. It is useful to know if any relatives or friends who live close by also share the same blood group. It is always safer to take blood from a known person who has no disease than to buy it from an unknown agency.

  10. Knowledge gives confidence and the ability to understand and handle situations. Nutritious food in the early years can help avoid chronic disease in adulthood and early death. Give both daughters and sons as nutritious food as you can afford. Send both daughters and sons to school. Children learn a great deal at school which could usefully be applied within the household.

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