The Weekly Dose: Using the Marie Kondo method to organise India's healthcare system
Can the mess that is the Indian healthcare system be put into order by following the KonMarie method’s dictum, “Keep only those things which speak to the heart, and discard items that no longer spark joy”?
If organising consultant Marie Kondo is asked to sort out India’s bewildering healthcare system, the first thing she may organise is a ticket straight back home to Japan. Many of our hospitals are overburdened and unaffordable, our doctors overworked and burnt out, and our patients confused, helpless, and angry. Can this mess be put into order by following the KonMarie method’s dictum, “Keep only those things which speak to the heart, and discard items that no longer spark joy”? I’ve made a laundry list of who would choose to keep or discard what, and why:
Tables: Not in hospital cafeterias or common rooms (where some more would be welcome), but in operation theatres (OTs); women with complicated pregnancies – some already in the throes of a dangerous labour – travel hundreds of kilometres from home to the nearest major hospital, but have to wait hours for their turn to deliver on a single operating table.
Chairs: of the dentist’s variety. Oral health is an unfathomable concept for our healthcare planners; my alma mater had over 200 full-time doctors, and two full-time dentists.
Beds: For the unending lines of patients who require admission, and for the exhausted resident doctors who treat them; who sleepwalk through the day and work through the night, crashing for an hour or two in some corner of the ward.
Respiratory face-masks: If perfectly healthy people who have never had to visit a hospital can end up contracting tuberculosis, how much more likely to contract it are the people who live and work in hospitals, and treat tuberculosis patients?
Suture material: Public hospitals need to perform hundreds of major and minor surgeries every day, but often run out of the sterile threads needed to finish them. All doctors prescribe medicines that must be bought from pharmacies; I’ve had to ‘prescribe’ silk and catgut to patients a day before their surgeries.
OT slippers: The Manmohan Desai Law of Vanishing OT Footwear states, “Even if a surgeon manages to find one right slipper that is even close to her shoe size, she will never find the slipper’s left twin, until all the surgeries are over”. In the OT complex, it helps to have two left feet - several shoe sizes apart.
Pens: When a doctor lends his pen to a colleague for even the briefest of writing tasks - like dotting the ‘i’s’ and crossing the ‘t’’ in ‘prescription’ - he knows it will disappear into the vortex of vanishing writing instruments, and will never clap eyes on it again.
Bags of donor blood: Every person who accompanies their ill loved one to a health centre is a potential blood donor, and can help save lives which are otherwise snuffed out by the reluctance of those who possess in abundance, the one thing the dead needed to live.
Lilliputian surgical gloves: that permit your fingers to enter them until the second joint, but no more.
XXXXXL OT scrubs: that hang off one or both shoulders, or threaten to reveal an urban forest of chest hair.
Paperwork: Senior doctors are kicked up the medical ladder and saddled with an inordinate amount of admin work, banishing them to their offices, far from patients who deserve to benefit from their years of clinical experience.
Cell phones: Which buzz incessantly – in OPDs, OTs and wards, while listening to and counselling patients, prepping for, performing and finishing surgeries, and teaching medical students how to become doctors. And at home, while eating, sleeping, or spending a precious half-hour with one’s family, before waking up the next morning to go to OPDs, OTs and wards…
Ampoules of life-saving drugs: During emergencies, doctors bark orders, but it is usually a nurse who finds and administers the drug that saves the patient. During my internship, I found myself in a ward full of patients recovering from head injuries, all of whom were at risk of developing seizures. The ward nurse - who held fort, while I pretended to be useful - informed me there was no stock of drugs to prevent or treat seizures anywhere in the hospital.
Nothing. I have had the privilege of working with crackerjack nurses who eke out the usefulness of every last thing for the longest possible time; the only thing they may want to rid themselves of are doctors such as I, who presume to understand their problems - or lack thereof - and write about them with impunity.
Hospital maps: In my alma mater, the Emergency Desk was at one end of the campus, and the CT/MRI centre at the other. Those who come to hospitals don’t know what’s wrong with them; hospitals make things worse by not directing them to the place where they can find out.
Stretchers: No one who has been rushed to a hospital after undergoing physical (or mental) trauma should have to suffer even more, by being subjected to the indignity of sharing a gurney with a similarly traumatised stranger.
Curtains: That can provide a modicum of privacy, after a patient tiptoes into a crowded OPD to get a lump in, an ulcer on, or a discharge from a private part examined, while ten inquisitive bystanders also listen keenly to the doctor’s embarrassing questions.
Free medicine samples: Pressed upon doctors by pharma salesmen, these strips - whose market prices are unaffordable for most public hospital patients - are quietly slipped to penurious patients by doctors who do not want to see them remain untreated for want of money.
Oxygen cylinders: Lest we forget Gorakhpur 2017, and the 72 hospitalised children who died because there were none.
Blood-pressure measuring instruments: Brought around by a junior nurse who wakes you up at 4 a.m, because her list of duties demands that your pressure be recorded at this hour, even if you’ve been admitted for piles.
Doctors’ white-coats: last washed in mid-2018, and stained with blood, ink, coffee and bodily discharges from various orifices; worn out, and worn by a worn out doctor who moves from bed to bed, offering patients their choice of breakfast bacteria.
As Marie Kondo says, thank them for their service, and let them go.