Many of the problems that are endemic in American health care, such as underuse, overuse, high costs, and unethical behavior, are prevalent in health systems around the world. Fortunately, clinicians in other countries are drawing attention to health care corruption, and uniting health care professionals against corruption and privatization.
Dr. Arun Gadre is one of these clinician activists. Dr. Gadre is a leader of the Alliance of Doctors for Ethical Healthcare, a group of about 100 professionals advocating for “more humane and non-commercial healthcare.” A champion of health care for all, Dr. Gadre has worked for decades to bring quality care and public health initiatives to rural areas of India, where access to basic care is limited. Dr. Gadre now works for SATHI, a non-governmental organization in Pune, India that has done groundbreaking and community and public health work.
Dr. Gadre came to Boston last week to give a talk, and we took the opportunity to ask him some questions about his experiences leading a movement for ethical and rational health care.
Lown Institute: How did the Alliance of Doctors for Ethical Healthcare get started?
Dr. Arun Gadre: It all began with the book, Dissenting Diagnosis, that I co-wrote with Dr. Abhay Shukla. We were both working at SATHI and having a casual discussion at the lunch table about some of the disturbing practices we were seeing in health care. We were hearing so many stories about kickbacks, corruption, malpractice, and more, so we decided it would be valuable to collect and document these stories, instead of just talking amongst ourselves.
We spoke with 78 doctors across the country and across specialties. We started with my friends who were suffering and would speak, and asked them about corporatization in medicine and how it affected them. We expected they wouldn’t want to talk about it, but people were so happy we asked about this because we were the first to bring up the topic. The doctors wouldn’t stop talking. It was a fantastic response.
“No one had ever asked these doctors what they thought about corporatization in medicine, so when we asked, they wouldn’t stop talking.”
Once the book was republished in English, it became a big deal. People couldn’t question that something was wrong in the system, because the message was coming from other doctors. We used the media to spread our message, and soon the media and the government started taking us very seriously. More doctors were hearing our message and although some were upset, many others wanted to join us. So we developed an Alliance of like-minded physicians to be a voice of conscience for health care in India. We now have a core of about 20 active doctors, with about 100 doctors in our network overall.
“We are a voice of conscience! When we speak, people listen.”
How have you experienced health care commercialization and corruption in your own practice?
I worked as a gynecologist for twenty years at a small rural town of Maharashtra, Lasalgaon in resource-poor conditions. The first ten years were like a dream; I didn’t care about making money, my patients had faith in us, and we were doing great work.
But over the next ten years, things changed. Doctors all over India started practicing medicine more like a business, doing hysterectomies and other procedures without proper indication to increase turnover and revenue. These doctors had so much money that when there were complications, they would just pay the patients to keep them happy.
“Doctors all over India started practicing medicine more like a business.”
Patients started expecting money for complications. I didn’t run my practice like that, and I did not intend to. But soon patients lost faith in me, they were demanding money and ready to attack me. That’s why I left the practice and started working for SATHI.
What types of projects do you do with SATHI?
We are working in many fields. One is community-based monitoring of public health care. We try to ensure that resources being provided for health care in rural areas is actually getting to patients. We work with town leaders in 1000-2000 villages to teach them about their rights and entitlements in medical care.
Power dynamics are an important issue in these villages. Doctors are such powerful people, and they often don’t want “common” people to question them. Patients are supposed to beg and plead for their help; it’s a very paternalistic system. What many people don’t know is that even though they do not pay direct [income] tax, the doctors get their salary through the indirect [sales] tax they pay when they buy anything. So the doctor is their servant, not the other way around!
The ADEH has come a long way in a very short time. We had a very successful first national conference on ethical medicine last April. A hundred doctors came from across India and many others from around the world.
But even with all the work we’re doing at SATHI and ADEH, from 0-10 we’re only at about a 4. And we’re frustrated about it, because it’s a systemic problem. The government is bent on privatization, so they’re decreasing investment in public health.
Private health care is a vacuum, doctors are being sucked into the private health system. We see this hurting patients all the time. For example, there was a farmer in a rural village who had taken out a large loan of 200,000 rupees, but the crops weren’t growing. He knew he couldn’t repay the loan, so he tried to commit suicide by taking poison. Someone took him to a nearby public clinic to save his life, but they didn’t have the antidote there and the doctor wasn’t even there, so had to ship him to the private medical center, where they saved his life – but now he owes the private medical center 200,000 rupees as well. It’s a dark comedy. He tried to end his life over 200,000 rupees, but now, because of the price of private medical care, he owes twice as much.
We just want doctors to do their rightful job.
We’re doing what we can, but the primary drivers of unnecessary care are so powerful and corrupt. We just want doctors to do their rightful job.