The fight to bring healthcare and revolution to India’s cities
Posted by redpines on January 17, 2012
In the context of revolutionary war in the Indian countryside,
communist forces are grappling with how to ignite and lead people’s mass struggle in the cities. Krishanu Mandal makes an argument for opening one such front of struggle in the demands for healthcare, fighting against cruel profiteering in the medical industry, and reviving a mass urban revolutionary movement.
While the CPI (Maoist) is busy now defending itself and its mass base of poor agricultural classesand tribals against a relentless and violent attack by the Indian state, a revival of revolutionary democratic work in the urban areas is an extremely serious issue. Once again we emphasize that a careful reorganization of the entire matrix of the working class and democratic mass movements in urban area is necessary and such a complementary movement comprising such concrete mass-political actions in the sphere of health might be one component of that.
Thanks to Joe for the intro, and for alerting us to this article. It originally appeared at Sanhati.
The Aftermath of the AMRI Tragedy: Some Related Thoughts on Democratic Work in Urban Areas of India
by Krishanu Mandal
January 5, 2012
This article provides a case for mass-political movements around health-care and expropriation of private health-care sector as one component of the revival of revolutionary democratic work in urban area.
The gruesome death of about 90 people, mostly critically ill and infirm patients, due to the fire at the AMRI (AdvancedMedicare and Research Institute) Hospital in Kolkata, India in the second week of December has made international news. This has been followed by a comparably gruesome death of more than 170 people by drinking poison-laced country-liquor in a region of southern West Bengal a few days later. The response of the common people to these incidents stimulates some introductory thoughts on diversification of democratic work in urban areas of India.
Let us take the AMRI fire incident first.
The background facts of the AMRI incident are quite transparent now. The hospital management did not inform the governmental fire services presumably because then it would have been officially confirmed that they have been violating fire-safety norms for long. Resident doctors were not present because the hospital seem to have been hiring junior unauthorized house-staff at some pittance for these jobs, a common practice in such private health care shops. Indeed, reading an account of the origin and development of this hospital is a masochistic exercise. The hospital is one of the first progenies, born in 1996, of the marriage between the greed of the business class and the CPIM, which had shed any veneer of communist ideology by the mid-1990s. The bonhomie was embodied at the personal level by the bond between Sravan Todi and Jyoti Basu. Todi, a pal of the patriarch, of course did not have to care a lot about legal use of land or safety norms for a public building. The Todis and the Goenkas and the Agarwals were not entirely ungrateful. In return of profitting perhaps billions, Basu and Subhash Chakraborty, two of the prime polluters of CPIM, were famously treated (and finally died) in AMRI, and not in any of the governmental hospitals of Kolkata where the actual proletarians perish due to lack of treatment, care and medicine. CPIM, of course, has mumbled protestations through `Ganashakti’, its Bengali mouthpiece, that they are not the sole thieves–that Trinamool Congress, during its tenure at the Kolkata Corporation, also had a finger in this pie.
The response from the administration and the “mainstream” political bodies so far has been along predictable lines. There have been candlelight vigils in Kolkata and formation of committees to oversee that fire-safety regulations are followed in public buildings. These committees are providing pious notifications to the errant institutions. When some rumblings rose about the Nightingale Hospital, another money-sucking machine in the posh part of Kolkata, governmental politicians soon assured that the hospital should continue its business as usual (yes, it gave a promise to take measures for fire-safety–just as AMRI did). The mighty police forces, who were so efficient in catching and then murdering Koteswara Rao (Kishenji), seem to be clueless about the whereabouts of Aditya Agarwal and Preeti Sureka, the high-flying, globe-trotting young scions of the Emami dynasty managing AMRI. Of course, it would be criminal for the police to torture the elder Goenkas and Agarwals to extract information as they did to Koteswara Rao (pictures here: http://indianvanguard.wordpress.com/2011/12/07/).
In contrast, the people in the Sangrampur-Magrahat region, where the mass-death by poisoned liquor took place, took swift action by themselves. They physically demolished the dens of manufacturing such liquors. The personnel of the local police station, famous for openly collecting cut-money from these liquor-based thugs (these thugs have a symbiotic life with CPIM and Trinamool Congress) locked the police station and fled.
The question that stands out then, is why, after the AMRI incident, did people stop merely at smashing the reception of another wing of the hospital. Why did they not invade the houses of the Todis and the Goenkas and the Agarwals, drag these big bosses out into the streets, punish them then and there and make them cough out fines of some crores of rupees–as allegedly happens in the famous “kangaroo courts” of the CPI (Maoist)–where justice for such blatant crimes are quick and immediately effective?
The private hospitals in Kolkata, and perhaps all over India, are almost literally “soulless, vampire bastards making money off human pain” (see Endnote 1). We do not know exactly the average rate of return for investments in private health-care in India, but the rapid pace of entry in this sector implies that the return must be abnormally high (see Endnote 2).
The very poor and destitute, of course, have no hope of ever being treated in such private hospitals and nursing homes–even though these were set up and are run, like AMRI, by direct assistance and munificence of the state governments. It is well known that, as a matter of course, such hospitals often decline to provide even life-saving emergency treatments to patients dying from road accidents nearby if they are not paid several thousands of rupees in advance (see, e.g.,http://news.asiaone.com/News/Latest%2BNews/Asia/Story/A1Story20100413-210095.html). Infuriated people sometimes react, but alas, again only by breaking a few glasses and computer monitors in the hospital buildings. And these hospitals continue to run their multi-million dollar businesses unimpeded, while some “official enquiries”, promised by disingenuous ministers (see Endnote 3) get conveniently forgotten over the years.
The people, certainly, can start taking steps for themselves in this regard. We are talking of those people who cannot pay the price of more than a thousand rupees to get a couple of X-Rays done from these private clinics and who, after waiting in a long queue in the cash-starved government hospitals, finally end up with a disfigured bone. Of those people who cannot pay several thousands of rupees for expensive blood tests and thus, may have to die undiagnosed. Of those people who cannot afford expensive chemotherapy in the AMRI Cancer Centre, who sometimes charge several thousands of rupees for injecting a blood-generating hormone and die a painful death, nearly untreated, in a local public health centre (if they are fortunate enough to get a bed). Of those people who have to mortgage their residence to have a heart-surgery done.
These people get angry at such injustice, they flare up bravely, but their anger gets dissipated and nothing sustainable emerges from these sporadic outbursts of the poor people’s justified anger.
This leads us to emphasize that health is an arena around which collective revolutionary activities can be built up fruitfully in urban parts of India perhaps with relative ease. While both time-tested class-based movements (like organized movements of the wage-labourers) and mass movements (like those against price-hike, privatization etc) are extremely necessary to fight against the relentless onslaught of the big capital and its local cronies on the common people of India, we put a tentative suggestion that generating a mass movement around the democratic demands of health-care may be a relatively easier task. First, this issue of healthcare has a universal appeal among the poor, the coalition of exploited classes. Next, unlike, for example in trade unions in organized sector, no revisionist caucus is occupying space here already, nor does there exist, in this arena, a history of betrayal by a leadership calling themselves communist. And thirdly, the spontaneity of protests by the common people against exploitation in this sector provides one encouragement.
Indeed, the space of such plausible movements in the entire matrix of urban activities of the revolutionary left has to be determined carefully by the activists with grassroot experiences. Also, the exact structure, formation and modes of operations for such activities in this sector, of course, would be shaped by concrete local conditions. However, below we give one possible avowedly utopian picture deriving from the recent and ongoing experiences of resistance movements in India.
People’s Committees at locality levels, the representative bodies of people’s power which brought about the mass rebellion against the oppressive CPIM in Bengal and which are leading death-defying struggles against multinational-imperialist aggression in various pockets in India, may be formed: People’s Committees for Health Security. Such committees can go to the various profiteering private health centres and find out how these facilities are flouting existing rules: using unauthorized structures, running commercial establishments in buildings meant for residential housing (and thus, availing cheap electricity and evading tax), dumping pollutants and hazardous substances and thus endangering the locality and so on…. Given the cheap cyber-access these days, documentation and communication of such evidences have also become easier. And then they can enforce some punishment instantly: for example, cutting illegal electricity supply will hit such private medical facilities where it hurts most as they have to switch to expensive private electricity generators. Moreover, they can also compel that the guility be fined punitively through mass agitations: thus expropriating these ruthless exploiters. The money thus collected can be spent in the local public health centres: so that these poor people themselves may reap the fruit and the functioning of these centres can also be actively monitored by such a people’s body. Quite naturally, these are steps also for establishing and asserting the genuine democratic power of the people, going beyond the periodic charades known as elections.
This sounds fanciful, utopian (and we emphasize again that the exact forms of such practices will, of course, be shaped by the relevant local conditions). Yet, the revolutionaries of the CPI (Maoist), the naxalites, have been implementing similar things for years in the more remote corners of India. Yes, such actions may require going beyond the existing legality of the Indian state: the state that kills Sidhu Soren and Azad and Kishenji, but actively arranges for Warren Anderson, whose excellent management led thousands to get killed in Bhopal in 1984, or Ottavio Quattrocchi, the noted thief of the Bofors case, to get into safety from Indian laws.
Of course we know that such assertion of power by the exploited classes will not be easy. The apparatus of the state will not sit pretty. To protect their masters, the big capital and its local allies and agents, the coercive apparatus of the state will pounce upon the poor people attempting such steps. Otherwise the Naxalites, fighting precisely for such people’s power, would not have had to take up arms and build underground organizations. The Indian state has proved that it is ready even to unleash a low-intensity civil war upon the common people to protect its interests, the interests of the exploiters. But the people can, and do, fight back.
It has been pointed out about CPI (Maoist) (and it agrees) that in very recent years this organization has been forced to sideline mass-political work, especially in urban areas. While the CPI (Maoist) is busy now defending itself and its mass base of poor agricultural classes and tribals against a relentless and violent attack by the Indian state, a revival of revolutionary democratic work in the urban areas is an extremely serious issue. Once again we emphasize that a careful reorganization of the entire matrix of the working class and democratic mass movements in urban area is necessary and such a complementary movement comprising such concrete mass-political actions in the sphere of health might be one component of that. We reiterate that launching such democratic work in a relatively virgin yet fertile territory provides another sphere where joint front among the working class, the middle classes and the students can be built up.
The Naxalites have shaken the Indian state in interior hinterlands–imported military choppers are hunting them now. Such complementary work in the urban areas would advance our revolution.
Endnote 1: This is a telling and famous remark made by Bill Maher, the liberal American comedian, on for-profit healthcare in the context of the nationwide uproar in US over the introduction of the ‘Obamacare’ (seehttp://politicalhumor.about.com/b/2011/01/20/best-bill-maher-quotes-ever.htm).
Endnote 2: The only academically rigorous work, so far as we know, which has analyzed aspects of privately provided healthcare in recent metropolitan India is that by J. Das and J. Hammer (in 2007 in Journal of Development Economics, vol 83, pp. 1-36). It shows the prevalence of needless expenses induced by private health-practitioners in Delhi.
Endnote 3: Whatever has happened to the misdeeds of the Peerless Hospital in Kolkata cited above (http://news.asiaone.com/News/Latest%2BNews/Asia/Story/A1Story20100413-210095.html)?