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March 25, 2004 -- Today the New York Times ran a generally good article by Celia W. Dugger about "[r]ampant absenteeism" among poorly managed, undersupplied government nurses and physicians in India, which has led to reliance on better supplied but potentially dangerous amateur "doctors." The piece's particular focus on absent nurses might seem unfair, but it does provide some explanatory context, and its clear recognition of the potential contributions of the nurses sends the message that they are (or should be) key primary health providers to the nation's poor. However, the story's misleading headline--which is all many people will ever read--reflects the traditional physician-centric bias the story itself avoids: "Deserted by Doctors, India's Poor Turn to Quacks."

The story explains that though India has a vast public health system, new studies and direct observations show that in practice chronic absenteeism and a lack of resources have crippled the system, as they have in a number of other nations. Factors appear to include mismanagement and a lack of basic supplies. Dugger notes that one public health nurse is even out of oral rehydration "salts" (solution), which can relieve deadly dehydration; the piece ends with this nurse shrugging at her crippling lack of supplies. (The story tends to describe the clinic nurses as "public health" nurses, though they appear to function more as primary care providers.) The article also points to other factors pulling nurses and physicians away from the villages to which they are assigned, chief among them the desire for a good education for their children, which apparently results in health care workers commuting from cities or sending their families to live there.

The inadequacy of the government health system leads patients to traditional healers and amateur "doctors," who may have little or no real training. Though these "doctors" charge fees the poor can ill afford, they are more available, have more medicines, and are eager to provide what customers want, which appears to be injections, regardless of whether they are appropriate. Dugger describes one young mother--from a village where "villagers say the public health nurse is often not at the clinic"--who went to an amateur "doctor" for a fever, received an injection from a shared needle, developed an infection, and died the next day, apparently of severe anemia.

In addition to quotes from villagers, an international health expert, and one of the amateur "doctors," the piece includes quotes from one government physician and two government nurses. Both of the nurses are depicted as failing to provide needed care, and the story probably could have been more explicit as to the reasons for their absenteeism--presumably a key factor is low pay, which is only implied by the article's description of the minimal resources India devotes to health. But the story did at least recognize that the nurses would have something to offer with adequate resources and management. The treatment of physicians is hardly more flattering; the quoted one says physicians posted to his village want to leave quickly, as he does, since he is an "educated person" looking for opportunity for his children ("If you allow them to mix with local children, they begin to use the local bad words"). In our view, even stories that are critical of nurses are commendable if they provide the necessary context and convey the message that nursing matters. Thus, we think the "Deserted by Doctors" headline--which might seem unfair to physicians, given that the article focuses more on the nurses--actually reflects pro-physician bias, because it implies that it is the physicians' absence that really matters.

See Celia Duger's article "Deserted by Doctors, India's Poor Turn to Quacks" in the
March 25, 2004 edition of the New York Times.


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