Lifestyle & Belief

India health: Spit and polish?

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NEW DELHI, India — New Delhi's All India Institute of Medical Sciences (AIIMS) is, arguably, India's best hospital.

But even though patients travel for hours – even days – to seek treatment here, they don't show the same respect inside its hallowed walls. A new survey shows that a whopping 90 percent of them spit inside the hospital building, raising the risks of dangerous hospital-acquired infections like tuberculosis, pneumonia, and swine flu.

Most hospital acquired infections are spread by indiscriminate spitting, concludes the survey, which was conducted by the Department of Neurosciences at AIIMS. The study found that attendants were even spitting in the corridors outside the ICU and isolation wards.

In other words, if you weren't sick when you got here, you might be when you leave.

“When we looked at the reason for spitting, about 80 percent said it was a habit, and about 16 percent said it was because they chew betel nut and tobacco,” said Dr. Manjari Tripathi.

Near the entrance to the outpatient department, as security guards move along the pavement, rousting patients camped here to await treatment, the challenge of keeping the premises clean becomes clear. Here and there patients and their families have set up impromptu picnics. In one corner, a man with a catheter restlessly shifts his bag of milky urine out of the sun next to a huge, blue signboard that is surely unintelligible to him. IMPORTANT NOTICE, it reads:

1. PLEASE PUT THE WASTES INTO THE DUSTBIN ONLY.
2. SMOKING USAGE OF TOBACCO, PAN MASALA ETC. ARE BANNED IN THE AIIMS HOSPITAL PREMISES AND IT IS PUNISHABLE IF FOUND GUILTY.
3. DO NOT SPIT IN THE HOSPITAL PREMISES.
4. GIVING FOOD TO MONKEYS AND DOGS IN THE HOSPITAL PREMISES IS STRICTLY NOT ALLOWED

Most of these people camped on the pavement are villagers. Uneducated and living hand to mouth, they've traveled for eight hours or more to get here, and after the guards kick them out they'll find a place on the median or beneath an overpass to spend the night until the hospital reopens in the morning.

“Of course the people are spitting here and there,” says 60-year-old Khajan, a villager who has traveled for five hours on local buses, only to face a long day of waiting for a doctor. “What difference does it make?”

That kind of apathy from patients who have bigger problems is only one of the challenges AIIMS faces.

While private institutes like Apollo and Escorts have earned the lion's share of headlines for attracting medical tourists from Britain, the United States and other developed countries, a typical 700-bed private hospital in Delhi treats only around 200,000 people a year, at fees that start around $25 a day for inpatients — nearly half the monthly salary of a lower middle class worker. Government-run AIIMS, with around 2,000 beds, treats 3.5 million people a year, charging only about $1 a day for in-patients and providing emergency care for free.

Even with government funding of around $100 million a year, budgets are strained. The student doctors who make up the bulk of the medical staff here earn only about $300 a month. The orderlies and cleaning crew are routinely asked to put in unpaid overtime to keep the place running. And the constant flow of nearly 10,000 people per day make the outdated building materials — which include rough concrete, cracked tile floors and windows that don't seal – almost impossible to keep clean.

“See, we are in India,” says one hospital employee, who asked not to be named. “We are Indians. We have our local standards. This is a public hospital, so the public will do what the public will do. We have to deal with it.”

To be fair to its beleaguered sanitation staff, though the ramshackle premises would come as a shock to a visitor from America or Europe, AIIMS deserves some credit for cleanliness. Inside the outpatient department, the floors show signs of recent mopping, and most corners are free of the blood red spit stains — the hallmark of the popularity of the betel nut-based stimulant known as paan — that are ubiquitous in most government buildings. One can only occasionally detect the faint scent of disinfectant. But that's leaps and bounds ahead of other Delhi institutions, like Lok Nayak Hospital, where the mysterious stink of seeping sewage is pervasive.

According to the hospital staff member who spoke to GlobalPost, lack of manpower is a bigger challenge than spitting. Showing us a contract for outsourcing the cleaning of toilets to a private firm for around $80,000, the worker laments the denial of a routine request for increasing the cleaning staff by a measly six people.

“We (the cleaning staff) have no authority, and no channel for promotions,” the employee says. “If a VIP is coming, we're called for duty in the middle of the night, with no pay for overtime. They want everything done right. But they don't do anything for us.”

And it's the poor people waiting to be shown off the premises for the night by the hospital guards who have to bear the brunt.

“Sure, people spit,” says 32-year-old Bhagwan, who has been making a seven-hour journey to bring his anemic wife here for treatment for the past three years. “People even take a crap if they have to. It's only because of that they lock us out at night.”