At what point does eliminating a choice become a necessity? The answer lies in a corner of Gurgaon, where people on the lowest rung of economic ladder ask whether government facilities are really meant for them.

“My sister-in-law was in labour for three days. When we took her to a government hospital, they refused to operate, telling us that the baby was dead. But we took her to a private nursing home for a second opinion. There, the baby was delivered safe and sound,” Sarita, 16, who works as a domestic help, says.

That is just one example of the state of healthcare for the poor in the national capital region (NCR). With no BPL card and little cash to spare, the poor who migrate to urban centres in search of a livelihood are losing out on options.

As more and more government schemes kick in, a BPL card, especially for those who have to support a family on little income, becomes even more important. The BPL card, which deliver subsidised ration and kerosene, also offers a gateway for medical facilities that include not only regular visits to hospitals but also operative costs.  

SN Makwana, public relations officer at Safdarjung hospital, explains the norms: “When patients come to the hospital, they are entitled to free medical facilities. However, if they have to undergo an operation, then they have to arrange for the costs. We do have government schemes under which we can sanction surgery and make it cost-free but to avail these schemes, one has to show documents, including a BPL card, income certificate and so on.”

The same is the case with institutionalised deliveries. In the absence of valid ID proofs and other documents, expecting women cannot be admitted to a government facility.

A small pocket of Sector 45 in Gurgaon illustrates the story better. Home to migrants from West Bengal and illegal immigrants from Bangladesh, hardly any of the 200-odd families here has a BPL card. The residents work as rickshaw pullers and household helps in the nearby apartments. This is a familiar story across Gurgaon. In their case, it is not just about acquiring the document, but more of a forced choice. They have to ignore the government facilities.

The reasons are many – from inaccessibility of government hospitals in the vicinity to uncooperative attitude of hospitals, down to negligence in some cases.
Just six months into the city, Ajiya Bibi works at a nearby complex, and lives with her husband and daughter. “In the past few months, I have had a lot of medical problems, especially with menstruation. But I would rather go to a local private doctor than the government hospital.” Asked why, she says the value of what you pay for is more in private clinics. “A government facility, as we know, is of little use,” she says.

Her assessment of government hospitals has been further clouded by what a neighbour had to suffer. “After she was diagnosed with breast cancer her family took her to a government hospital in Delhi. First, they didn’t give her a bed, and her husband had bribe the hospital staff. Then I don’t know what they did to her but she died within three days,” Aliya says. “The husband had already spent so much on medicines and bribes that he had no money left for the cremation. Luckily, an auto-rickshaw driver friend of theirs helped them out. He collected Rs 1,500 from neighbours and paid for the last rites.”

The issue of bribe is a recurring problem for the disadvantaged when they go to government hospitals for treatment. Having no BPL cards, these families become easy targets.

Joya Bibi, a widow who works in a nearby apartment, says, “After my husband had a heart attack we rushed him to Safdarjung hospital. But they asked for BPL card there. Since we did have one (he family still does not possess the card), they asked for a bribe. Even my employer, who had accompanied me to the hospital, could did not help. In the end, we paid over Rs 1 lakh. But my husband passed away even after all that – I don’t know what treatment he underwent.”

Manik, a contract labourer in his late thirties, has tuberculosis but is adamant that he will not go to a government hospital. “I used to drive an auto-rickshaw. I have driven a lot of people to government hospitals and I have seen what goes on there. I will never go to a government hospital for treatment. I am willing to go back home but not there.”

Dr Bipul Gupta, a private doctor who is visited by many such families from the slums of Sector 45, explains, “No one here has a BPL card, so none wants to go to a government hospital. They have had bad experiences there. For example, a patient of mine had once asked a nurse about food when he was admitted at a government hospital. She shouted and threatened him. If you treat patients like this, would they ever come back to you?”

Raju, an auto-rickshaw driver, refuses to go to a government hospital for the treatment of his recurring fever. Instead, he spent a hefty sum on a private doctor. His sceptism about the government doctors is born out of experience.

People have some hope in the state government-run General Hospital at Sadar Bazaar which charges only a nominal fee and does not ask for identification.
“Patients have to come in and get an OPD card made. It costs Rs 5, and lasts for a year. This covers the consultancy fee and the cost of the medicines. All they need to do is to come and give the required details: name, age and address. After that we do not care if the person is Bangladeshi, Australian or whatever,” says Shankar, a hospital employee.

Here, various facilities are available to the poor, like free delivery for pregnant women. Under the state health programme, a pregnant woman is also entitled to free ambulance service from her residence to the hospital and back.

Yet, what stops the slum dwellers from visiting state government-run hospital is the distance. To travel to Sadar Bazaar in a shared auto-rickshaw costs over Rs 50. Instead of paying that much, and spending a lot of time there, the locals choose to go to a nearby doctor and pay Rs 250, and get better treatment.

Ajiya Bibi says, “We cannot take offs. And travelling all the way means you waste half a day. That’s not possible. Also, travelling here costs a lot. I would rather spend that amount on a better doctor.”

Then there are those who are not even aware of the government healthcare facilities in Gurgaon. Every time Suman Puriyar is ill, her brother takes her to a private hospital. “We do not know the area well. So whenever I have a back pain or leg ache, I just go wherever the neighbours suggest.”

For people earning barely enough for food, healthcare is not a matter of choice. Yet, they choose to say ‘no’ to government hospitals, simply because they do not have BPL cards and other ID proofs. For them, it ultimately becomes a choice between life and money.

(This story appeared in the June 1-15, 2013 issue of the print magazine)