The Doctor and the Umbrella

The following is an excerpt from Staying Alive by Ramani Atkuri.

On a wet July morning in 2018, I found myself seated in the room of Dr Gupta, the Block Medical Officer (BMO) of a CHC in Panna district, Madhya Pradesh, waiting for him to finish signing a stack of files. For years, he had been the only doctor at the CHC, running the block hospital single-handedly. The nine other sanctioned posts were vacant. Dr Gupta sat at a large desk cluttered with papers and files. A man in a khaki uniform stood behind him, holding an umbrella over his head as he worked, protecting him from a slow but steady drip of water from the ceiling. A sheet of blue polythene had been tied under the ceiling, but this too had developed leaks in a few places. Hence the umbrella.

Ramani Atkuri,
Staying Alive: Dispatches from the Margins,
Pac Macmilan (2026)

I was not seated opposite the doctor's desk, but about 10 feet away at an angle. It soon became clear that the chair I occupied had been strategically placed to avoid drips from the ceiling. The walls were damp and showed signs of fungal growth. Another thick blue polythene sheet covered the floor, which was now wet and grimy from people walking over it. A single tube light cast a dull light. A cupboard and a refrigerator in the room had been pulled at least a foot away from the damp walls to prevent further damage.

I was there on an assignment to evaluate the quality of non-obstetric health services in public hospitals in Madhya Pradesh. The districts of Panna and Jhabua had been selected for this purpose and I had visited the district hospitals, as well as a few CHCs and PHCs. As I watched the BMO work, I marvelled at Dr Gupta's resilience — his ability to show up each day and work in these dismal conditions. He managed immunisation, antenatal care and the control of communicable and non-communicable diseases; saw both outpatients and inpatients and attended to hospital emergencies. In addition to all this, he handled the relentless administrative paperwork that came with the post. What did it take to face such challenging situations and do one's job? I wondered how long I would have lasted had I been in his place. And would I be able to multitask like Dr Gupta was doing?

Eventually, the paperwork was done, and Dr Gupta offered to show me around the hospital. He explained that the building was very old and that, while funds had been sanctioned for new premises, construction had been repeatedly delayed for various reasons. The X-ray machine lay unused — the dampness had rendered it unsafe, and the walls of the room where it was kept gave electric shocks when touched. A blood storage unit had been delivered, but could not be installed because there was no space. It stood there, all steel and glass and shrouded in a thick, transparent plastic sheet. The hospital store was musty and lacked sufficient racks, often damaging medicines and supplies. The entire facility was falling apart, but no one in the health directorate seemed to understand how difficult it was to work in such circumstances. The out-patient department was in slightly better condition, though not by much. The walls still bore patches of dampness, but there was no obvious leaking. 

With no other doctors available at the facility, patients were referred to Panna's district hospital for admission. Only emergencies, such as diarrhoeal dehydration, were admitted; they were managed by the nurses and could be discharged soon. The nurses also handled normal deliveries. The image of the doctor working under the umbrella and the condition of this block hospital – serving around 100,000 people — was a stark illustration of how the public health system functioned. It reflected the low priority the government gave to health, the indifference with which health services were provided and was a perfect example (or an excuse) to justify privatising healthcare.

While there are many proponents of privatising healthcare in India, legitimate concerns remain. These include greater inequities in access for poorer populations and higher healthcare costs. India's record of regulatory oversight of such public-private partnerships has been weak, often resulting in poor-quality care and unnecessary costs. During the same visit, I noted that though the district-level laboratories were supposed to conduct a wide variety of tests, many were not being performed. No pathologist was present for microbiological investigations, such as analysis of body fluids or cultures of blood or urine. Others were routinely outsourced or not done due to a shortage of reagents. At the block level, testing was limited by the absence of supplies, while some were done using expired kits. A well-functioning lab is essential for primary healthcare, and not having one risks an incorrect or incomplete diagnosis or referral elsewhere for tests, thereby increasing costs.

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