A Short Ethnographic Note on Hospitals in City H
To respect privacy and confidentiality, the names of the city and hospitals mentioned in this post have been altered.
During the last week, I have been a resident at hospitals in City H. Don't get me wrong. I don't mean to say I became a 'hospital resident' in the manner MBBS doctors become surgeons; I had to become a resident in the same manner a pigeon becomes a resident in a warm duct during winter. My mother-in-law is sick. She was diagnosed with an aneurism, and I rushed home to City H to take care of her and lend support to my family. At first, she was admitted to the famous X hospital in District P, City H. We then moved her to Hospital Y District P. During the last week, which was filled with equal volumes of silence and noise, I learned quite a bit, and I thought it would be a good idea to document it, much like an Ethnographer. Let me start by painting a picture of what X Hospital felt like.
X Hospital - The early days
Hospital X, District P is the spick and span place that is part of movies. The place is filled with glass, paintings, and beautiful tiles. Its visual appeal is unquestionable. The doctors, the nurses, the attendees, everyone speaks English. It is organized into a well-lubricated money-making machine. This part becomes very apparent once you take a patient to the ICU. In our case, three teams independently met with us and took stock of the situation. It was uneasy for my family members to at least talk to doctors about finances. What if they provide her with less care to cut corners?
Another interesting thing that I observed is accommodation. On the other side of the road is a smaller (yet massive) building transformed into a dorm. Within the first floor of that building are 50 beds, each placed in a cubicle. The beds are for rent, at Rs. 300 a night, with reasonably clean toilets and bathrooms that get dirty due to use. The cubicles are only partially enclosed, and one could quickly lose their belongings. Unlike other locations shared by many people, like restaurants, parking lots, etc., where there is a board, "Management is not responsible for loss of property," there was no such board here. There were CCTV cameras everywhere. No one knows if it was working and if people were watching on the other side. However, the cameras kept relocating regularly and ensured that theft was not a concern. I had left my belongings, including my laptop, charger, and other materials here, and they were extremely safe. The only time someone came over inside in my presence was when someone wanted a charger to charge his phone.
But then, I would not like to argue that the reason for their 'good behavior' is simply the surveillance mechanism. I'm sure going around filing a police complaint, or any other complaint for that matter, for a small article such as a charger can be quite a hassle and that no one would be chancing someone that way. But then, everyone there was an 'ICU attender,' meaning they were relatives of ICU patients. They were united in their suffering. Someone in their family was possibly very critical and on the verge of death.
This understanding of others' plights perhaps played some role in their 'good behavior.'
After about four days and paying up two years of our savings to the hospital, we discharged her from there against medical advice. We felt the entire operation was not geared towards the patient getting better but to do as many procedures as possible to extract money from us. The fact that they had their org chart printed on a large canvas for people to see and had a grievance redressal mechanism and a 'counseling' apparatus did not contribute to confidence building. This place was primed to take maximum advantage of what economists call the 'agency problem.' By admitting our patients here, we have made the hospital organization an agent in providing her care. We have no idea if they are doing what is in the patient's interest or if they are enhancing their well-being. The idea of trust was missing, and the fact that CCTV cameras were pointing at us even when we slept was not helpful.
Perhaps someone with enough money could get a room somewhere outside and move beyond the reach of these cameras. But then, that's not something that everyone could do due to their monetary constraints and their emotional connection with the patient.
Hospital Y - the quasi-governmental hospital
Hospital Y was an altogether different setup that was in sharp contrast to X. Little did I know that the hospitals on either side of the road could be worlds apart in how they organized things. While this was strange to me at first, I think a lot of what Hospital Y had going on was for good reason, and I'll come to that in just a bit.
Hospital Y in Hospital City H is a quasi-governmental hospital that was set up decades ago. The hospital offers advanced medical care at an affordable price. For those who were covered by the medical insurance offered by the central or the state governments, care was provided at no or very little cost. Now, this is where the difference in consumer behavior begins to show. While the people who visit private hospitals such as X are either covered by insurance or can pay really high sums of money, the patients who come here are from the general middle and poor classes of society. While the fancy atmospherics of the private hospital ensure that people regulate their behaviors, here, their behavior is more natural and raw.
As a person seated in Hospital Y for almost a week, I was surprised to see how much value co-creation was occurring at the facility. Let me explain what I mean by this. One of the patient's attendees was supposed to help with any required medical service. To move the patient from the bed to a stretcher - call the attendee. To get the blood tested before surgery - call the attendee. To get pharmaceuticals from the medical shop nearby - call the attendee. This was the case with every part of the medical care provided at the facility. At first, I thought this was a mechanism to avoid transaction costs and, therefore, lower the cost of care provided there. There was some merit to this line of thinking. In a place like X, they would have had to pay someone to ensure each task was performed on time. Here, a motivated individual had a stake in the process. It was revolutionary, I thought.
But that sort of thinking was rather superficial, and I later understood it to be. The fact that an attender was always around ensured that there was absolute communication between the doctor and the patient, and that meant that during difficult procedures that had a significant downside, the attender was always there to understand the risks firsthand and, in turn, ensure that the doctors were safe. Turns out, there were many instances when the doctors were beaten up when a patient died in the hospital. I can understand how this would never have been the case in a private facility, but this was a real possibility here. Along with value co-creation, there was also a push to lower the risks of such events.
The risk in Hospital Y was higher, and that's simply how things would be. Hospital Y did not reject any patients, and they often got very risky cases in large numbers. I heard the dean tell my family members that we were lucky to have secured a bed there because there were always 20 ambulances outside Hospital Y's gates. This is true.
There was never an instance in that week that I did not hear the sirens of ambulances blaring while having chai downstairs.
The flip side of this story is that the doctors in Hospital Y were excellent. By being forced to take care of extremely tough cases, they were trained to offer high-quality care for the masses. Think about the most advanced surgical procedures these people had you covered. There was an entire floor of operation theaters just for neurosurgery. I'm positive somewhere in that large campus in the middle of District P, City H, similar floors were filled with surgeons specializing in heart, kidney, ortho, and other procedures. In the neuro ward where I was placed, there were two theaters and three teams of surgeons, NS1, NS2, and NS3. When we were trying to find out when surgery was scheduled, one of the chief doctors remarked that he would schedule it as soon as the OT was free. Imagine, the OT had to be 'free'.
On the other hand, it was always free except when a serious case came their way. This is perhaps why Hospital Y was one of the best teaching hospitals in the location. It was filled with many young residents training to become expert surgeons. While they may not continue to serve the poor at Hospital Y in the years to come, they could get such a breath of surgical expertise only in places like these.
The stay in Hospital Y was nothing to write home about. Unlike in X, where they were gearing you up to stay for the long haul, they wanted you to get out as soon as possible. And they left no stone unturned in making your stay as uncomfortable as possible.
Each attendee was expected to have only one attendee in the building at any time. This made sense because they tried to ensure the doctors were safe from people ganging up against them in case of an untoward incident. But then, this also ensured that the person there was always on his or her toes and ready to go to the ICU or outside in case that became necessary. On my first day there, I was asked to go get milk for the patient at 8, at 9 to get ORS, and then to get some Ragi later. On day two, I ensured everything was delivered on time, even before the nurses requested it. While this was partly because of my OCD, it was also true that I did not like them calling for me.
In just over the first 48 hours of my stay there, many faces I had made friends with went missing. They did not go away from there because their respective patients were okay and were discharged, but because many passed away. Once in a few counts, after the security guard or the nurse came out of the ICU calling for someone's attention, the person had gone in, and quickly, a loud round of crying followed. Their patient was no more. Like I said, many faces I had made friends with had gone missing. and something was always keeping you from hoping for good things to come. It was scary when the nurse called our patient's name, and therefore, I made it a point to go there and ask the attending nurse what the patient needed every once in two hours. after completing the tasks, I picked up a book and started reading. I was the only one in the hospital who spoke only in English ( I still can't speak Telugu), and I was the odd one out since I was reading when others were busy on their phone or chatting.
Things in between
At the time, it was a running joke between some other attendees and me that no one would take my book away while running errands for the patient. I could not read anything serious. I had picked up a historical fiction called Krishna Deva Raya. A friend came to me and asked me if I had something unrelated to religion to read. I had to explain to him that the novel had nothing to do with Hinduism (the religion) and was about a king. We live in such a polarized environment that the 'Krishna' in 'Krishna Deva Raya' becomes a liability.
A lady and her sister were my first friends in the place. They told us they had been there for one month and one week so far. Both girls were pink. I was not sure if that was their complexion or their faces flushed with blood due to all the crying they were doing. They had developed some level of expertise about the place. They knew where to charge the phone when the tea guy would come, what the doctors' leave schedules were, and where the best food was available. Their mother had sat on the back of a scooter (one which their brother was riding). She fell when he sped over a speed breaker. This resulted in a fractured skull and a dislocated brain. They told me that the long stay had made their mother develop an infection in the brain that was being treated with antibiotics. These girls had shown me how to smuggle phones and chargers into the ICU to charge them. Turns out, there were no charging points anywhere else in the building (remember what I told about making it difficult to stay there). On my third day there, their mother had passed away. The girls had left, and two men took their place to complete all the formalities. I never heard from them again. Just like their familiar faces were replaced, every face in that waiting room was slowly getting replaced. And every replacement seemed to suggest that my turn was drawing close.
Do you remember the ads we see on the highway that tell us not to drive fast or to wear the 'crown' while being 'king of the road'? Making everyone sit as a patient's attender in a neurosurgery ICU will make all the difference. A simple helmet could have saved her life; now, those two girls will never have a mother. Their kids would never play with their grandmother. This could have been completely avoided.
Night stay at Hospital Y was an altogether different experience. People slept on the floor. Broken pieces of cardboard became their mattresses. Their hands magically transformed into pillows. The snoring of people simply failed to register. It was only the call of the patient's name that our ears could hear. Everyone was so tired that just a tiny corner to curl up in was all they wanted at the end of the day. While everyone came from different walks of life, they wanted to get out of there as early as possible. They wanted their patient to be the 'lucky' ones, and they prayed to their gods for everyone's wellness. There were so many tears that the walls of that room had seen and so many cries of loss and suffering that echoed through those corridors. Everyone was united by the panic caused by the security guard who came out and read our patient's name from a chit. and In that moment, everyone's heart beat faster in unison.
On the fourth day, sometime in the afternoon there was a politician from one of Telangana's opposition parties who visited the ICU. In addition to meeting his constituent who was admitted there, he also met others and made promises. Those new in the hall felt relieved by listening to his sweet words. But those of us who had stayed there long enough knew that no amount of promises from anyone would be of use. Only the skill of the doctors inside the OT and the healing touch that only Time could provide was of use. The politician left as quickly as he came in.
The place was not gloomy at all by any measure. Individuals were always chatting with each other. You could see the angry daughter scolding her father for riding recklessly. There were the parents of the young boy who had fallen from a height. There was also the odd case of someone who was pushed against the wall. but all of them sat together and smiled and shared stories food, and chai. It was a small commune that held a lot of promise. A promise that was broken by death and the occasional healing.
The sixth day
For me, all hell broke loose on the sixth day, a day that I cannot forget no matter how much I need to. It was time for me to leave the place, and I had joined the multitude of faces that had come and gone through these hospital corridors. As I walked out of Hospital Y, I carried with me not just the weight of my mother-in-law's loss but also the uncertainties that lay ahead and a tapestry of emotions and revelations.
I had witnessed firsthand the stark disparities in our healthcare system, the resilience of human spirit, and the shared vulnerabilities that bind us in times of crisis. The contrasting experiences at X and Hospital Y were more than just about healthcare; they reflected our society's priorities, challenges, and the undying hope that persists even in the bleakest of situations.
Amid clinical efficiency and impersonal transactions at X, I longed for a sense of empathy and connection. At Hospital Y, amidst the raw, unfiltered humanity and communal support, I yearned for the comfort and order of a more resourceful setup. This journey was a stark reminder of the delicate balance that healthcare systems must strive to achieve - a balance between quality care and human touch, between technological advancement and accessibility, and between individual needs and communal welfare.
As I left the hospital, my thoughts were interrupted by the sight of a young family bringing in an elderly relative. Their faces were etched with worry and hope, a mirror to what mine must have looked like just days ago. In that moment, I realized that our stories were not just our own; they were part of a larger narrative of struggle, empathy, and survival.
This experience, though harrowing, has left me with a profound respect for the medical community, a deeper empathy for fellow sufferers, and a renewed awareness of the fragility and preciousness of life.
One thing was very clear throughout it all - the indomitable spirit of humanity to endure, to care, and to hope, even against the most daunting odds