Socrates asks his pragmatic young debater Thrasymachus (Book I, Republic):
“But tell me, your physician in the precise sense of whom you were just speaking, is he a money maker, an earner of fees or a healer of the sick? And remember to speak of the physician who really is such…” (Plato, Republic)
Although Thrasymachus, argues that the idea of justice is nothing but the advantage of the stronger, responds by stating that physicians are healers first.
If the question was to be asked in today’s medical environment, Thrasymachus’ answer would be very different. Today’s physicians seem to be predominantly purveyors of a commodity and not the healers Plato had imagined.
With the exceptionally high cost of medical services aboard and long waiting lists. People from the developed countries often to come to less developed countries for treatment as costs are relatively less and treatment can be a lot more efficient. However, people from the under developed countries often turn to their neighbours for medical treatment, due to a shortage of medical facilities and underdeveloped medical technology.
Here I will focus on the medical travellers of Afghanistan who seek medical treatment abroad in India, and explores how ethnical medical professionals and interpreters are when dealing with Afghan patients in India.
The Medical Market in Afghanistan
Certainly there has been a huge change, the physicians are no longer mere healers of the ill, and they are using the medical profession as a way of increasing their income and making more profit. This has been the case since the exponential growth of private medical hospitals as well as private clinics since the fall of the Taliban regime.
The private sector has become really dominant in Afghanistan, there is a great demand for their services, not only for self-employed medics but hospitals and diagnostic centres. Despite the high fees charged, and the increased price of medicine, patients continue to seek primary care from private rather than public care providers.
One may assume that the popularity of the medical sector is due to a success rates and public feedback, but this is not the case. Doctors are working in unethically for profit at the expense of the poor and vulnerable. When patients visit private hospitals they are prescribed several tests, including scans, blood tests, etc. Most of the time, these tests are irrelevant to patient’s sickness, but as the patient is unaware of their illness they hardly question the doctors. After being seen, the patients leave the hospital with several packages of medicine, some of which have side effects and may even be harmful to patients liver and kidneys, cause further illnesses and therefore bringing them back to the doctor for further treatment at a later stage in life.
In Afghanistan the health sector is a blooming business for many, it is seen as a lucrative business and a way of earning cash by taking advantage of the corruption and lack of health regulations in Afghanistan government.
The Ministry of Health has taken several measures to curb unethical practices in the health sector. However, all of these steps have been ineffective in controlling the greedy and unscrupulous people who earn huge profits by exploiting people in different ways. There should be procedures that monitor the fees that are charged for medical consultations, tests and treatment, and strict action should be taken against those practitioners who prescribe unnecessary tests and medicine to generate profit.
If such laws were enforced, these businessmen would not dare to enter the health sector attempting to make a profit with their unethical business practices. The problem does not stop here, another very important problem in Afghanistan, is the lack of genuine Pharmaceuticals. Hundreds of pharmaceutical companies import medicines from neighbouring countries without proper regulations. All these unethical and malpractices in private medical sector in Afghanistan opens the door for more people to seek medical care abroad and loose trust in the sector.
In the past very few people could afford to travel to India for treatment, as they had to arrange travel documents, purchase tickets for travel, arrange living costs while there, and more importantly have money for treatment. However as people are very critical of the medical practises inside Afghanistan most people arrange the expenses by whatever means, either way borrowing, selling or leasing the land, or receiving remittance from abroad to receive better medical treatment in India. However their miseries do not end by just leaving to India.
The problem starts from the moment they get out of the airport, especially those going for the first time, and are not familiar with either Hindi or English languages. Upon my recent visit to Delhi I found ground breaking facts about the way Afghan medical tourists are being robbed.
Serious illness tends to change the sick individual’s perception of himself, and forces him to confront the fragility of his own existence. If he wishes to be treated, he is required to seek help regardless of whether his illness is serious or not, he puts his live in the hands of utterly strange people trusting their humanity. The only thing the sick person asks for is the restoration of his health. However the people, upon whom the patients trust their lives with, eventually betray them for their own material greed, very similar to those medics within Afghanistan.
The patients become victims of a competitive medical market in India. From hospitals to medical stores, they all have their own policies of attracting patients, with the ultimate price being paid by the patients.
The process starts when the patients approach the interpreters. So who are these interpreters? The interpreters are the people from Afghanistan who have refugee status in India and almost all of them are employed in the medical tourism business in Delhi, from interpretation, arranging accommodation, restaurants, broker to fill the FRRO forms and medical stores. Each interpreter has developed his/her own network with hospital and chemist shops. Despite their daily charges from patients the interpreters are earning from the hospitals as well as the chemist shops. Upon taking patients to hospitals the interpreter receive money called as “referral fee” ranging from 10 % to 25% on the final bills; some hospitals even have the flexibility of increasing the final bills so that the extra many goes to the interpreter.
This explains why some patients with very minor health problems have had to undergo surgery? It’s because the interpreters reap the most benefit if the patients undergo surgery and it’s only when the hospitals pay the “referral fee”, the interpreters play major role in convincing the patients to undergo surgery.
It’s not all the interpreter will settle for, in 2007 when I was in India the interpreter took a patient to complete some check-ups, he collected the money from the patient. The patients are quite often illiterate, and have not come across some of the technology available in India. The interpreter took him to the elevator, the elevator was new to the patient, and the interpreter took advantage of this, so he went as far as charging him for using the elevator in order to complete a medical check-up. Then they take the patients to chemist store, who they talk to as the patient cannot communicate with the pharmacist, this is in their interested as they can talk about how they can also take a share of the money they charge for the prescription
The chemist’s shops are usually owned by Sikhs from Afghanistan, who have their own policy of how to attract Afghan customers, through deceiving means. They usually write in Persian which is not comprehendible to Indians, having the luxury of writing in Persian gives the more tools to attract patients. I was awestruck to see boards written in Persian and few of them caught my eyes reading stating “Government of India foreign exchange and Government of India pharmacy”. I was really eager to know why they used the phrase “Government of India”, and came to the conclusion that it was to gain legitimacy through being seen as a government body. This idea was working very well for them and the chemist shops which used this phrase were really crowded by Afghan customers.
I was curious to find out about the about the legality of writing such a phrase: “Government of India”. So I asked a person involved in medicine business, who requested to remain anonymous told me that “there is nothing such as governmental or public chemist shop in India, and the reason the chemist shops write it in Persian is to avoid legal prosecution while at the same time attracting Afghan costumers.” As, in India the government run chemist shops are located only in public run Hospitals.