Everyone needs an Indian Aunty. Ok, aside from the hassling and badgering that comes with Indian Aunties (“Have you eaten enough?” “Are you working hard?”), they are a special breed. Why? For the purposes of this blog entry, an Indian Aunty expertly navigates the winding roads that make up India’s healthcare system. The Indian Aunty is a confident, brash force of nature. She will demand and yell to get clear answers and proper attention from medical staff. The best Indian Aunties could probably pass through the first year of medical school or manage a small hospital.
On a serious note, I cannot be more grateful to my actual Masi (aunt), in particular, for worrying and ensuring I have the best care possible in India. She is one of the best. I have been lucky enough to have my Masi, cousin, and many other family members, friends, colleagues and AIF Fellows/staff in India and abroad as my support network over the past year.
Warning: This story lacks brevity.
The Ear Drum Conundrum
What started as an ear ache [imagine a 5 year-old in a man’s body] before Diwali weekend, has led to a months-long immersion into the affluent side of the Indian Healthcare system. As many expats will tell you, traveling or living abroad often invites strange and unexpected ailments. I couldn’t remember the last time I had an ear ache. Usually I think I can take care of myself, and my previous experiences in India left me thinking seeing a doctor was unnecessary for such a small problem. In December 2012 I suffered through a 10-day “Welcome-to-India-Flu” running the gamut of symptoms (India simultaneously destroys and strengthen your immune system; I’m still waiting for the strengthening). What struck me the most was the over-prescription of pills to combat the flu – mostly in the form of pain medication (see: Combiflan and Paracetemol). Secondly, in June 2012, I fought a bout of food poisoning, which resulted in a quick trip to the ER at a private hospital. These two experiences, distorted my personal views of healthcare in India – that of pill popping and using the ER for primary care. Coming back to the story, my ear ache has, at times, confirmed initial impressions while also given me a thorough journey into India’s healthcare system.
Family doctors and Home remedies
After some prodding from my mom (yep, still a five year-old), I stopped to see my aunt’s neighbor. She is a general practitioner, and acts as the informal doctor for everyone in the area colony. I don’t know to what extent she is related to my aunt’s family, but that really didn’t matter. Although she wasn’t present, her family somehow remembered me and treated me like a family member. I sat down for chai to discuss cricket with her husband as the family tried to reach her via phone. Eventually, she gave a free consultation and she listed out my prescription of ear drops and pain medicine. I was off to the pharmacist (without a formal prescription) to collect the medicine for less than Rs 100. This sequence of events would never happen in the US.
A complementary step to formal doctors and medicine is the informal home-remedies. Without fail, my mom will always suggest ginger tea and a lot of waters/fluid to cure any sort of sickness. As everyone was on holiday for Diwali weekend, I was left to my mom’s hot compress solutions and friends’ remedies – from swimmer’s ear treatment of jumping on one foot to hydrogen peroxide solution.
Specialist Private Practice
To see a specialist in the US, patients go to their Primary Care Physician, receive a referral, then explore who is in their insurance network, and hope to have an appointment in a week or longer. In India, the Indian Aunty network will find the “top notch [insert type] specialist” in the city. The specialist, of course, will need a reputation, which means someone in your friend/family network knows them, and as a result, you can get an appointment in a matter of days (if not the same day). As my condition worsened, my cousin found a well-known ENT (Ear, Nose, and Throat) specialist after Diwali and accompanied me as my advocate. When your advocate joins you for the appointment, the advocate will introduce him/herself and the connection to the doctor, before describing your health situation. Or… maybe my family is over-zealous.
This informal system of referrals makes such highly-trained and proficient specialists accessible, but only to those that can pay out-of-pocket. The appointment with the specialist costs up to Rs. 1000 in cash. I still have no idea what role insurance, for those Indians who pay for it, plays during these instances.
The ENT declared my problem as an ear infection, and of course, prescribed another set of ear drops and pain pills. After a few back and forth consultations (in person and over email), different rounds of pain medication and ear drops, the ear infection was still winning. The next step, according to the ENT, would be taking course of steroids (steroids?!? Cue inner dialogue of steroid misconceptions and level of severity).
Pharmaceutical phenomenon – I’ve already said a lot about my fascination of over-prescription and the ease of picking up medication without a prescription from the pharmacy (reasons for the large Indian pharmaceutical industry. Really, though, I think the picture says it all:
The romantic view of India indulges in spirituality, aryuvedic massages, and all sorts of treatments of the body and mind. I was still “suffering” through my ear infection, and I wasn’t comfortable with the idea of steroids. I decided I would try an alternative source – Homeopathy. When I was younger and had a cold, my mom sometimes would serve up homeopathic medicine. Though I never understood it, I decided to explore this appealing all-natural medicine for my ear infection. I approached this on my own (with the help of internet research), but… somehow I ended up at a Homeopathy/Life Wellness Center (curiously, the only place mobile phones aren’t allowed in India?). On top of discussing my ear infection, the doctor put me through a quick a “Body Evaluation” and tried to convince me to membership to forever solve all my body problems in the next few months. The body evaluation was taken after just stepping on one machine, and resulted in all sorts of metrics about my (lack of) health. Overwhelmed at the prospect of a Rs. 7,000+ membership fees, I ran out of the clinic without a fix for my ear.
Luckily, my Masi’s Indian Aunty Network had a relative who was a homeopath in the housing colony, who concocted tiny, white balls of medicine and colorless/flavorless liquid to drop into the mouth. Web MD defines the process as, “A homeopathic health practitioner (homeopath) uses pills or liquid mixtures (solutions) containing only a little of an active ingredient (usually a plant or mineral) for treatment of disease.” Odd remedies accompany homeopathic medicine, including not eating onions or cold food, and giving hot –compress treatment to the ear. Even the doctor at my project’s free health clinic in Pune gave me new ear drops. I finished the homeopathic course of medicine with the new ear drops, but unfortunately my condition did not improve.
I relented and bought the previously recommended steroid course from the pharmacy (again, without a formal prescription). Unsurprisingly, my ear was still in intermittent pain and my hearing was comically poor. My Masi was getting impatient, and tapped into her network to get me an appointment with a different specialist, this time based out of a hospital in Mumbai.
[Please continue onto part 2]