Healthcare: How the Church can stay relevant

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Healthcare: How the Church can stay relevant

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.

CJ: Shantanu Dutta

Wed, Jan 30, 2008 17:32:43 IST

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Christian in India :

THE CHURCH and the Christian community in India have always been justly conscious and proud of their involvement in two sectors historically - education and healthcare. This involvement has been an interesting one and can be traced to a time when church-run healthcare meant charity and charitable institutions. Today, many church-run institutions are involved in a variety of initiatives, including adoption of a rights-based approach, which really represents a paradigm shift. In India and other developing nations, the health-care services provided by the church and NGOs need to be evaluated and new strategies for improving the effectiveness of the services need to be adopted especially at a time when even the legitimate concerns of the church are looked upon by many with unease and suspicion.

If the Christian institutions and churches have earned recognition for their contribution to society in the past, it was because they were relevant to the times and the healthcare needs of those days. If we want to retain that appreciation or regain that stature, we need to re-discover and reclaim that position by doing three things, all of them at the same time: be advocates for the poor and the marginalised as the scriptures instruct us to do; be the best and most effective in all that we do and be the champions of constant innovation and change 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 may have been.

The church, which historically provided healthcare through its institutions, is today saying that healthcare 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 from a minority community and its institutions and should be applauded. Such initiatives should in fact expand in their scope. Now what does all this mean?

The flagship programme of the government in the field of health since 2005 has been the National Rural Health Mission. The purpose of this mission, among other things, is to strengthen the primary health centres (PHCs) and sub-centres and create a network of rural hospitals. The direction that NRHM has taken has led to the increased privatisation of healthcare services in the country. While privatisation of healthcare is good or bad warrants a separate discussion, can the church, with its numerous institutions, clinics and committed manpower, step in to provide low-cost and ethical healthcare? If that could be done, it would mean that the church’s own resources are freed up for other things. It will also translate into 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.

Despite the growing reality of public-private partnerships, participation of Christian institutions in this arena is still a largely untapped opportunity. Apart from this, can the church, with other like-minded and committed organisations, act as a watchdog to ensure that the resources allocated are actually being used effectively and usefully? The church, with its numerous dioceses, parishes and mission stations, has a countrywide presence, which is an unparalleled advantage.

The Indian system of medicine is again one of those areas, which deserve attention. The Indian system of medicine and homoeopathy continue to be widely used owing to their accessibility, efficacy and affordability. The Indian system is also embedded in the beliefs of a wide section of the public and continues to be an integral 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 too, there is a resurgence of interest in the Indian system of medicine. People are becoming concerned about the adverse effects of chemical-based drugs and the escalating costs of conventional healthcare. Longer life expectancy and life-style related problems have increased the risk of contracting chronic and debilitating diseases such as cancer, diabetes and mental disorders.

Although new treatments and technologies for dealing with them are emerging, more and more patients are now looking for simpler and 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 to end the long neglect of these systems because the various indigenous systems of medicine are the ones that are typically patronised by the poor, being affordable and rooted in the country’s folk traditions. Even the WHO (World Health Organisation) Charter on traditional medicine encourages health systems to immediately address the 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 traditions. The unfortunate result has been the marginalisation of the Indian system of medicine that has been practised in India for thousands of years and has benefited millions of people over the centuries. In fact, a lasting contribution to the promotion of the Indian system of medicine can be made by the church by setting up an institution of the stature of CMC (Christian Medical College), 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 health services provided outside the big cities. Government institutions and hospitals tended to be in the cities, the whole chain of primary healthcare institutions were non-existent and so what little was available was provided by the church. Today, it 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 - the poor too use it 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 not favourable from a social and political point of view, our institutions not only have to survive and thrive but have to be the best. But what is best? Many corporate hospitals have emerged today, which, technologically speaking, offer everything, provided you have the money. And increasingly the choice lies 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 falling vacant. The social costs are damning. P Sainath, in November 2007, cited a study done for WHO in six Indian States. It found that 16 per cent of the households it surveyed were pushed below the poverty line by costly medical treatment. Nearly 10,000 families from lower income groups were covered by the survey for the period, 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 reason. I hope that day will not come when patients have to sell their home and hearth to settle medical bills in a Christian hospital to avail of the ‘best’ healthcare available.

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, which in fact can become a protocol for others to emulate. Maybe 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 neighbour of his people has evolved over the centuries and must continue to do so.

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