What do you get as a reader when a writer of fiction, and also a surgeon who has worked closely in both the public as well as private health sector, picks up her pen to write on the state of the health system in the country?
The answer is easy: you get a book that lays bare the fact that the health of the citizens of a nation is an investment, that the health system is a part of nation building and effective governance and that it is time to learn from mistakes that have been made and continue to be made.
You get a book that comes from years of working amidst the dust and the grime of government health care set-ups, from having observed the profit-oriented approach of the private sector. A book that offers quiet hope that things can, and must, improve.
What’s wrong...
Kavery Nambisan’s first work of non fiction, A Luxury Called Health: A Doctor’s Journey Through the Art, the Science and the Trickery of Medicine, is exactly what its title says, with little drama or exaggeration. It is an honest examination of this thing called healthcare, of the systems that are working and not working, of the people who are its faces and, at times, because of whom, healthcare turns into what it should be: effective, affordable and something that can be trusted by everyone.
A passage from Fyodor Dostoevsky’s The Brothers Karamazov, where a doctor examines a terminally ill patient in a very poor home, that features in the introduction is an apt reminder of what happens when the poor try to access healthcare: the hope and despair felt by the patient’s loved ones and the disdain that the doctor projects. It sets the tone for what follows in the subsequent chapters.
Later, Nambisan conveys how patients and their families often put doctors and healthcare staff on the pedestal of demigods and do not try to find out about the nitty gritty of how illnesses are treated. This makes them resort to threats and abuse when things do not go as they should.
From the early traditional medical practices to the first steps taken in India to institute a medical institution to train and educate health-workers and medical staff, the author puts the focus on how the poor health of individuals affects the overall well-being of a nation. She takes readers into the time the seeds of a new nation were being sown and, along with them, the hopes and aspirations that went to building the health care system. It was a task made more difficult by entrenched caste practices, such as those of not even touching corpses, leave alone dissecting them as medical students.
Nambisan’s note of appreciation for the first wave coming from Kerala when it was still a profession that had few takers soon after Independence is a reminder of how far the health care system has come. But, as she shows with anecdotes and analysis, with this has come disparities between the public and the private sphere when it comes to health.
... And what’s right
What works for this book is that it stays clear of rhetoric or the blame game. Instead, it injects humaneness through personal insights while making a point on how the health system is interconnected to nutrition, poverty, hygiene, water, and sanitation. Nambisan makes the point that urban development ends with more buildings but little attention to, among other things, waste and rainwater management and water resources, which in turn, affects the health system. She emphasises that treating medical situations on a case by case basis, without a holistic strategy for improving health, leads to little progress.
Thankfully, none of these heavy-duty issues weigh down the book and for that we have the quality of her writing to be thankful to. Perhaps only a writer of fiction used to the economy of words would have been able to cover such complex matters in a little over 300 pages. There are no appendices with tables and data, for the author speaks from her own long years of practice, with quiet, unwavering authority.
The use of anecdotes from the history of medical practices across the world and in India, peppered with the author’s own experiences, makes the book come alive in a way that is informative as well as thought-provoking. In one chapter that details the list of medical procedures in a health set-up, Nambisan admits how easy it is to treat patients as mere technicalities, and that it takes a lot to probe further or ask questions of a supervisor or senior colleague.
There is little of handwringing or giving into hopelessness, even when the book details corruption and political apathy, as well as greed. In a chapter titled “Doctoring Reality”, the author highlights rural initiatives started by medical practitioners who have given up lucrative placements to set up affordable and accessible services. It makes you wonder why we don’t see many of these inspiring stories in the mainstream media.
Towards the end the author takes readers into her personal space, as a spouse having to play part- bystander and caregiver when her husband, the acclaimed poet Vijay Nambisan, is diagnosed with cancer.
Kavery Nambisan’s voice is gentle but firm, with words of caution about how critical it is to listen to the voices on the ground, the doctors who work in remote areas with poor resources. For they are the ones whose intervention saves lives, instead of following protocols laid down by international organisations like the WHO, especially in the wake of the Covid-19 pandemic.
A Luxury Called Health is an important book, one that needs to be read and discussed. It exposes the failings of the medical system in the country over the years, but it also shines a light on the people who mend worn-out bodies and organs, bringing hope and succour.
Chitra Ahanthem is former editor of Imphal Free Press, a newspaper published in Manipur. She is also a Manipuri-to-English translator.
A Luxury Called Health: A Doctor’s Journey Through the Art, the Science and the Trickery of Medicine, Kavery Nambisan, Speaking Tiger Books.