An Intro to Indian Health

May 22nd, 2023

On this day, I took a trip with the FIU and Barry University students to JSS Science and Technology University to attend two lectures. One lecture was an introduction to India's healthcare system and the other discussed Indian health techniques. I found both to be extremely informative and useful to my work as a future health professional. This post will go over some of the major things I learned during these lectures as well as how I will be able to relate them to my work as a doctor in the United States.

The Indian Healthcare System

India is a democratic country that serves a wide variety of people across its states. Currently there are three major types of burden of disease in India: communicable diseases, noncommunicable diseases, and diseases that impact child and maternal health. India has the high rates of rabies, tuberculosis, HIV, and leprosy which are all infectious diseases. India also has a high burden of vaccine preventable diseases like tetanus. Additionally, an improvement in India’s socioeconomic status caused communicable diseases to be replaced by noncommunicable diseases like cancer and diabetes. Finally, maternal and child health are all major concerns in India. Every child in the subcontinent is undernourished and a lot of women die due to complications of pregnancy. Additionally, there are high neonatal mortalities and 70% of women are anemic. On top of that, all health burdens in India are complicated by COVID, which eats away at funds and resources. India had four waves of COVID, but non-governmental organizations (NGOs), civil organizations, and the Indian government helped lower COVID rates.

A public health system in India was needed because they had a high burden of health problems, so in 1952, India implemented a family planning program which started a series of health programs with the intent of addressing India’s burden of disease. India wanted to address India’s birthrate which is three times more than its death rate, causing an exponential increase in its population. India also wanted to address the high maternal mortality which was caused by uncleanliness and the young age girls were becoming pregnant. One of the ways they addressed this was through abortion, which slowed population growth and prevented maternal mortality. Women could get abortions before 12 weeks if the women’s life was in danger, contraception failed, or eugenic complications arose in the fetus. After 12 weeks and before 18 weeks, the abortion had to be crosschecked, but it has helped prevent several preventable deaths.

India’s healthcare system has four sectors: the public sector which includes primary care and hospitals, private sector which includes hospital, nursing homes, and dispensaries, indigenous systems that attended to rural populations, and voluntary agencies which include several NGOs. Health centers function as primary care centers in India and hospitals are curative. The most basis healthcare is offered at villages. Each village has 200-400 families to attend to which are all taken care of by Accredited Social Health Activists or ASHAs who are female non-government servers. These women are identified by the people of her community, need to have at least completed 10th grade, and needed to devote their time to serving society. They go to each house once a week to ask each family about their health and has performance based incentives. 1 ASHA serves around 1000 people at a time and report to health and wellness centers. Under ASHAs are Aganwadi Workers (AWW) that take care of the community’s education and nutrition. Then there are Community Health Officers (CHOs) who complete training as health assistants. CHOs will know how to do basic healthcare but are not doctors.

Each primary health center serves approximately 30,000 people. These centers have medical officers, senior health assistants (who supervise CHOs and ASHAs), lab technicians, and clinical staff working here. Primary centers also have the diagnostic systems, offer curative care, and provides health education to people. Community health centers cater to 8000-120,000 people. These centers are more specialized. They have general physicians, surgeons, nurses, technicians, gynecologists, pediatricians working here. Additionally, they have ultrasounds and operations taking place. District hospitals cover 500,000 people and have various departments.

I made a map of the general public Indian healthcare system setup shown below:

Although this healthcare system works decently, there are many healthcare challenges India must address to improve their quality of care. One challenge is that there is no control over the private sector, so often they do things that aren’t great for the overall health of people. Another challenge is the underutilization of these resources which less people being treated when needed. Additionally, the quality of healthcare under these systems are always questioned as there’s no feedback system. As in many other countries in the world, there is a deficiency of health personnel as well which also affects healthcare quality. Finally, there’s lack of political and administrative commitment to public health as well which leads to less resources and funding being allocated to health.

Unani Health Technique

Unani is a Perso-Arabic traditional medicine practiced in India and Muslim culture in South and Central Asia. It is based on the four humors: phlegm, blood, yellow bile, and black bile. It is believed that if all humors are balanced and in harmony, a person's health will improve.

There’s many types of therapy in this practice to help restore one’s health. These include:

1. HIJAMA or “Cupping Therapy”: This therapy’s aim is to remove abnormal blood from the body. It treats high blood pressure, eczema, migraines, paralysis, anxiety, depression, aches, and more.

2. Massage: This therapy treats the musculoskeletal system and is preventative and curative.

3. Leech Therapy: In this therapy, leeches are placed in areas of concern to filter out “bad blood” and restore circulation. It’s for musculoskeletal disorders, gynecological disorders, skin conditions, and thromboembolic diseases.

4. Venesection: This type of therapy follows a similar concept as the leech therapy, where you let out blood except it is more general and lets out more blood than the leech therapy.

5. Purgation: This therapy uses laxatives to eliminate toxins, watery matter, plague, and yellow bile. It’s for constipation and live diseases. One way to do this is to insert castor beans into the rectal region.

6. Emesis: This therapy is the forceful expulsion of gastric contents used to treat headaches, pneumonia, mental disorders, and asthma.

7. Hammam Therapy: Also known as Turkish bath, this therapy uses a hot bath to strengthen immunity, fight disease, control obesity, treat paralysis, and excrete waste through skin.

8. Irrigation: This kind of therapy involves pouring medicated water on an affected area to help fight against disease.

9. Enema: For this therapy, a tube is inserted through th

e rectal region to remove superfluities from the stomach and intestine.

10. Exercises: This therapy helps to maintain physical fitness and health.

11. Fomentation: This therapy involves a process that keeps the body warm. It relieves pain and increases circulation.

12. Inhalation: This type of therapy uses breathing techniques to eliminate waste from the body and provide warmth and relaxation.

Although this practice is pseudoscientific, it has helped many people across India help regain their health.

How This Applies to My Work in the States

Oftentimes I catch myself thinking about how the United States' healthcare system can be improved. One of the ways to do that is to look at other countries to see what is or isn't working. I find the Indian healthcare system extremely interesting. We have a lower-middle income country that provides free healthcare for everyone. Yet in the United States, a high income country, healthcare is not a guarantee for all. How can a lower middle income country provide free healthcare to everyone, but a high income country can't ensure all their citizens get healthcare? The difference comes from differing ideologies in each country and distinct set ups which lead to advantages and disadvantages in both.

India believes healthcare is a basic human right and as such offers free outpatient and inpatient care in public facilities. Indian citizens do not need to worry about whether they can pay or not. But they do have to worry about the quality of healthcare. Oftentimes, there's staff shortages, lack of funding, and no feedback system to get input from patients to improve quality. This creates long wait times and poor quality healthcare that doesn't always help the patient. Additionally, although citizens get visits for free, the cost of medication is high due to doctors prescribing brand name medications. The citizens do not opt for generic brands because they lack education and feel safer with whatever the doctor prescribes, even if it's more expensive.

The United States, on the other hand, doesn't believe it's the government's responsibility to provide healthcare for its people. That is up to the individual. If the individual gets a good job with great health benefits, good on them. If they get a poor job with terrible benefits, that's their choice. If they have a job that doesn't give them any benefits and doesn't allow them to afford insurance, they should have worked harder. What that does is create a system of "who deserves what" which often marginalizes people of color and LGBT people who disproportionately face higher burdens of disease while also receiving the lowest compensation. And while many in America do get quality healthcare compared to people in India, those who are receiving the brunt of America's poor healthcare are, again, marginalized people who don't have the resources or the generational wealth to receive otherwise. The system works for some, often White cisgender, heterosexual Americans, but not for others and that's a huge problem with the State's healthcare system. Everyone deserves healthcare. Healthcare is a basic human right. That's one thing India got right with their system.

Observing the healthcare system and how it functions in India was eye opening for me as it allowed me to see different ways a country can take care of their citizen's health. Although each system has their advantages and disadvantages, both can learn from each other to create better systems that reach more people and improve their quality of health. India can learn from the States to improve their quality by implementing similar feedback systems and policies that improve the functionality of their healthcare. Additionally, the United States can learn from India's ideologies and work towards providing healthcare for all of its people rather than only certain, more privileged populations.