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Robin Hood

Sunday, March 23, 2008

There are twelve beds in our ICU. At any given time 4-6 of these are occupied by what we call “Poor Free” patients. These are patients who are poor and can prove it by a Government-issued card. (There are enough bureaucratic hurdles to establish this that treatment is delayed to a certain extent in a large proportion of patients. But that’s another story.)

If you have this card, the hospital does not ask you for the daily charges, which amount to about 1-1.5 USD. The hospital also provides you food and some medicines free of cost. But these are basic drugs, including antibiotics for which our resident bacteria in the ICU have already developed resistance. And then there are the disposables – suction catheters, central venous catheters, urinary catheters, endotracheal or tracheostomy tubes etc. which the patient has to provide, whatever his economic status is. If the patient (or rather his family) can’t, what do you do?

Rarely, about once a year, some family member of one of our patients volunteers to provide for another patient. One of my residents spends about a couple of hours each day phoning up charitable agencies and philanthropic people for specific assistance for specific patients. The hospital has the provision of giving approximately 50 USD per day per patient for medicines etc. But this can occur only on working days. The forms need to be submitted each day and the money comes late in the day. You can’t ask for it in advance. And there is an official cap on the total amount. So the Medical Superintendent sometimes complains that we in the ICU are monopolizing all the money, while it is needed in the Casualty, in the Labour Room, in the Medical Emergency. And sometimes he is right. So what do you do?

That’s where Robin Hood comes in. None of us will officially admit it, but most paying patients have extra items prescribed. These are then used for the poor patients. I know this is not fair to these patients; many of them are not so well off that they aren’t at risk of bankruptcy themselves. But what is the alternative? Watch while the “Poor” patients die of septicemia, receiving only ciprofloxacin and amikacin, and putting all other patients also at risk by increasing the pool of antibiotic-resistant organisms? Some of us do it more and some of us do it less, but all of us do it.


From → Health, ICU

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