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Eh, what's up, doc? Emigration


CHIDANAND RAJGHATTA Musings on life, politics and economics from TOI's Washington correspondent

Immortality is a fate worse than death, someone joked, but that does not prevent most people from seeking eternal life. It's not that I'm afraid to die;I just don't want to be there when it happens, the comedian film-maker Woody Allen once said, revealing a deeprooted American anathema, more pronounced than in much of the world, for death. Indeed, Americans are suckers for life, howsoever tough and painful it may be, which is probably why more verbiage is expended on the subject of healthcare and more money is spent on extending life in the United States than in most other countries.

In India, we tend to be rather blasê about death, accepting it as one of those inevitable things that happens in the cycle of life. Perhaps the resignation comes from expectation of an afterlife or reincarnation - or simply that life has been such toil that death is seen as a relief or release. But Americans, they go kicking and screaming if they have to, looking to milk the last breath - and the last buck - out of life. The art of dying graciously is nowhere advertised, one of its writers said, in spite of the fact that its market potential is great.

Another way of looking at this is life is regarded as precious in the US, and conversely, cheap in India. A couple hundred people dying in an accident is just a blip in India's life;such an accident would be staggering in the US. America seldom forgets its dead, especially those killed by its enemies. The 9/11 attack, which killed nearly 3, 000 people, was cataclysmic for America, and revenge was swift and ruthless, even if largely misdirected. India doesn't care for its martyred soldiers, much less its citizens killed in various terrorist attacks.

In India, we have had several incidents in the last three decades in which more than 2, 000 people have been killed each time - the anti-Sikh riots in Delhi in 1984, the Nellie massacre the year before;communal riots in Mumbai and Gujarat and so on. Not to speak of natural disasters like earthquakes, floods, and an epic tsunami. We took it all in our stride with karmic elan - or shocking apathy. Many Indians feel when life itself is a struggle, one does not have time to worry about death.

This reckless indifference to life, and the scale of needless deaths, could be one understated reason why Indian physicians continue to emigrate in droves to the US and other western countries. Oh sure, there are many other reasons, from simple economic well-being, better work environment, newer technologies etc, but saving or extending a life in developed countries is rewarding in more ways than one. Indian doctors in the US puff up with pride when they speak of their work and what they have accomplished. In India they barely get time off from saving lives;often there are just too many lives to save. Which is why you have to admire all the more physicians who stay back in India.

The net result of all this is the US has 27 doctors per 10, 000 population, some 10 per cent of them physicians of Indian origin;whereas India itself has only six doctors for 10, 000 population, one of the lowest ratios in the world, despite cranking out the largest number of medical graduates in the world. Doctors simply decamp from India and their great worldwide reputation is thought to come at a loss to healthcare in India. In fact, if countries such as Saudi Arabia, Kuwait, Algeria etc - not to speak of the other great Commonwealth magnets like UK, Canada, and Australia - score more doctors per capita than India, it's because of the munificence of Bharat Mata's medical education system.

Now along comes a health minister whose solution to this problem is to require Indian doctors going to US for advanced medical studies to post a bond to ensure their return to the country. Such proposals typically have the support of swadeshi socialists, but it's a nonstarter. Why just US, and why just doctors? Why not engineers or economists, folks from areas where there are manpower shortages, perceived or real? And has the minister weighed what Indian emigrants have brought home (in terms of remittances, know-how etc) compared to what the government spent on their education?

The fact is the right to emigrate is a fundamental human right under the UN Charter. And India's healthcare crisis is not on account of shortage of doctors alone, but a variety factors ranging from poor medical infrastructure (one of the lowest hospital bed count at 9 per 10, 000) to lack of universal health coverage. But most of all, it is our sheer indifference to life, evidence of which is splattered across our roads, hospitals, and headlines. We can romanticise it by presenting it as calm acceptance of death compared to the passion with which other cultures cling to life, but the hard truth is we are uncaring about and indifferent to the most precious thing given to us: life - especially if it belongs to someone we don't know.

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