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Who builds a hospital?

Updated: Nov 1, 2022

In my first job in Shaheed Hospital as a freshly graduated medical doctor, life was rewarding experiences that were pulling my heart in all directions; not always in a gentle way. But they were worth having and putting in my diary.

One such experience has a 50 year old short heighted skinny farm labourer Nirupa Bai taking on one of our nurses and me. She expected me to order an investigation which I thought was not required for her and when she found out that I haven't written it on her patient card, she was furious and lashed out on the nurse saying,

“My mother lifted bricks here when this hospital was being constructed and you… denied me the test !” Her discontent was conveyed to us clearly.

We could convince her at last that she didn't need the test but that is not the point. Patients do ask for investigations of their choices, medicine of their choice and even doctors of their choice all the time. It's fairly common. But you will see these demands under 2 main categories-either as a humble request or as a practice of influence. Nirupa Bai’s demand originated from a sense of ownership. Her reason to claim that test was unique to me. For the first time I was seeing someone claiming something inside a hospital in return for her labour and not money, power and definitely not musculature.

At night when I told this incident to Dr Jana, who plays the role of administrator, doctor, colleague and friend for everyone at Shaheed Hospital, he said “You will see this very often here” with a trail of gentle laughter and left.

Shaheed Hospital is a product of people’s movement. The intense struggle for rights by labourers of the Iron Ore mines of Chhattisgarh in 70s and 80s compelled thousands of labourers to go beyond their capacity, sacrifice for their goals and eventually, create institutions for their own well being and continuity of the thought of the movement. Movements which are just and rooted in collective pain of people, create beautiful things out of collective conscience. Things that live long. Longer than the movement itself. One such thing is the hospital, which the labourers constructed with their own money and hands. It stands as a symbol that an earnest struggle should lead to creation and the creation would in turn enable the continuity of struggle- SANGHARSH AUR NIRMAAN.

The hospital for which the workers lifted bricks, has earned trust of the population it serves not just by providing quality care, but mostly by directing its growth towards their needs. The participation of labourers in its inception, workforce and management has ensured that the hospital raises the same questions as labourers from its work. Someone finds a bed here not because of a compassion banked on charity but because of a commitment banked on social accountability which itself stands on the spirit of collective struggle.

This post is neither about mounting praises for a movement which is long over, nor about portraying an ideal picture of the hospital and other initiatives that were taken along with it. A movement is a call of time itself and we must not be very naive to plan for its re-production. The question in focus is- who builds the hospital and why it should be talked about ?

With directionless globalisation bringing immense investment of capital in healthcare’s business model, the health organisations and hospitals most of all, have become places with a little space for people’s voices. Even if there are voices, they are as misdirected as the investment. The shining hospitals centered in cities have pumped the balloon of heroism which modern medicine proudly carries over its head but little space is there for social accountability. The neoliberal model of development, being eerily accepting of capitalism paved way for its own misuse by the capitalist forces and the gross inequity you and I suffer are largely attributed to it. Needless to mention the newer forms of colonialism like the TRIPS agreement which have created horrible pictures across the globe. People have died because of lack of drugs which were manufactured with their own labour in their own country. In this context, it is worth emphasising that a capitalist economy would never create a model for holistic healthcare where community participation is taken into account. It has failed to deliver health for all and heavily relies on perpetual crisis for its survival.

Charity on the other hand, smiles and promises to do relief and does so in many places. Although it doesn't challenge the basic structure of the healthcare system and provides services through the same model, the only difference is that someone else pays for these services. It does not answer the basic question of inequities that are vital in providing relevant, acceptable health care to people. Morphine to the rich, charity also paves way for being misused by the market forces. Above all, charity steals away one of the most precious things from the beneficiary; struggle for survival.

The poor working class which stands at the end point of all kinds of violence, innately has the power to challenge the structure of dispensing any service. When it creates anything, the creation is a reflection of their pain and aspirations in equal amounts, precisely what happened with Shaheed hospital. Not taking funds from any other organisations, the hospital has been running since 40 years true to its commitment of providing healthcare to the ones who have to struggle for it the most, the ones who are ignored in the race of industrialisation, the ones who are often rendered insignificant by the market. Moreover, the hospital is still the place where a patient finds his ethnicity on the bedside and the freedom to thump his foot down saying ‘my kind built this place’.

It is a reality that the worldly forces this hospital challenged since its beginning still exist, only emboldened. The heat generated in the friction between the work of the hospital and corporate bodies is apparent and survival has not been easy. Amidst expansion and sophistication of hospital services in the last decade, the question of sustainability is often brought under spotlight. The legendary issues like intelligentsia, manpower, money, motivation and innovation repeatedly surface and attract intense discussions, few of them get translated into action. Never functioning in the surplus of funds, the hospital faces periodic blows to its grit to serve. Often, work is done by sustaining losses, but the biggest problem is eroding solidarity of the working class that believes in an institution like Shaheed. However, the trend that the hospital saw in its patient turnover during and after the Covid-19 pandemic, when people impoverished due to the illness and the laws imposed in the meantime, disappointed by all government and corporate hospitals, turned to Shaheed Hospital. This has only increased our belief in the relevance of the model presented by the labourers and urges us to put forward the thought that it is only the working class which can care for the working class in ultimate crisis when all the tall, shining promises of the health system have been rendered inadequate and above all, irrelevant. We strongly believe that through this experience, the idea of the working class’s participation in health care should be explored once again in the present context.

As a young doctor whose association with Shaheed hospital has been for a little over thre and a half years, I can say that learning medicine from a proletariat’s point of view has been a majorly transforming experience. The walls here which tell the story of sacrifices by the deprived utilised for a greater good of people, have secured a culture where you can not talk of medicine without sounding contextually relevant to the person you are treating and this way, I have seen many humanistic principles transcending into practice effortlessly; the supreme of them being love. In many senses, it has brought me down from the arrogance of ‘working for the people’ to the gratitude of ‘working WITH the people”. On the path to achieving perfection in person-oriented holistic health care, minimising differences between the beneficiary and benefactor is important and a system built by the ones who suffer the crisis provides great hope. There we see a space for creativity, there we see a place for struggling with right questions in mind, with one question taking the centre - who builds the hospital?

Dr Vidit Panchal

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