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THE MEDICO-SOCIAL SCHEME OF PINGALWARA

The Institution is tackling the problem of sickness in the medico-social sphere in an original way. It admits every patient who is in need of care whether he is curable or incurable. A sick person needs the indoor services of a hospital not only for the treatment of his diseases but also for his meals, clothes, shelter care and maintenance in other respects. Every sick person does not have a relative to support him nor does every sick person possess money for his maintenance. Many of them numbering thousands and lakhs are not only unattached but are also paupers. Every sick person who is physically unfit to earn his livelihood has the divine right to be looked after through men and organizations working in the field of social service and charity. This should be treated as the basic and fundamental right of every human being. If a sufficient number of hospitals for the indoor care of sick persons cannot be brought into existence for lack of funds or other reasons there is no reason why voluntary medico social institutions for the care of such people should not be started. It is here that our countrymen have erred grievously. If institutions have come into being for orphans and for the aged and the infirm why should similar institutions be denied to the sick. People think that it is not their business to give any thought to a destitute or to an unattached sick persons but that of the hospital authorities to look to every aspect of his need. It is true that the task of diagnosis and treatment of a disease has to be done in a Hospital. But if free hospitals are unable to give indoor treatment to every destitute patient and can treat almost all of them or most of them in their outdoor only, then it is up to the people to enable the destitute patients to avail of their services from their outdoors by providing them food, shelter and other essential miscellaneous needs through medico, social institutions.

Among the needs of a sick person the one which is particularly related to a hospital is diagnosis and treatment of disease. But so far as the non-medical aspect of a patient’s care is concerned it can be equally undertaken by non-medical institutions which can easily convert themselves into social-medical institutions for this purpose. When the hospitals are able to treat the majority of patients only in their outdoors the non-availability of indoor treatment to them is no small challenge to the people of the country for a response in the shape of social-medical institutions; but it is regretted that they have failed to apply their mind in this direction.

Institutions for the ordinary care of sick person are essential for other reason also. The Hospitals in India have very limited bed-strength. It is far below the actual need of the vast numbers of sick persons. The shortage of beds in hospitals in, however appalling in the case of the mental and tuberculosis patients.

A hospital has two functions to perform- to provide medical treatment to a sick person and to diagnose the disease. At the present time hospitals in India in many cases can only diagnose diseases and can provide medical treatment to patients only in their outdoor. In some cases the hospitals can only diagnose a disease but can do nothing in the matter of its treatment outdoors. So the problem of sickness is reduced to the provision of institutions which may take care of patients and may connect them with the hospitals for their diagnosis and treatment as outdoor patients.

The T.B. clinics at the present time only diagnose the disease and do very little in connection with its treatment. But diagnosis of tuberculosis itself not a cheap affair, it is very costly for poor people.

Now, we have to see how every T.B. patient could benefit from the T.B. clinics. Some years ago I read that the T.B. clinics were not opened in all the districts in the county. But even if they were functioning in all the towns in which the headquarters at the district are situated, even then every T.B. patient of the county cannot benefit from them. Not to speak of the people living in the lakhs of the villages of the country even all the patient living in the towns of the T.B. clinics cannot benefit from them. Every T.B. patient required help from an individual or an institution in many ways so as to connect him or herself to a T.B. clinic. A patient might be unfit for walking or he might not have money for a conveyance from his village which might be situated at a distance of many miles from the clinic. Even if the patient managed to reach a town in which a TB clinic is situated, he cannot stay in that town unless there are arrangements for the supply of meals, shelter and other similar amenities. Above everything else is the question of his care. In an advance stage a T.B. patient might not be able to walk. So an institution was required which could look after the TB patients in every way. A T.B. patient, unable to move, has to be attended to in many ways. Such institutions were needed not only for patients coming from the countryside from long distance but also for unattached and destitute patients in the towns having T.B. clinics.

Then we have to look to the aspect of the infection of disease. There is an adage, ‘prevention is better than cure’. Preventive measure have a very great role in the prevention of this disease. Out of ninety lakh T.B. patients in our county, 30 lakh are advanced cases capable of transmitting their disease to other healthy persons who come in contact with them. Advanced cases of T.B. need to be segregated from healthy persons. Segregation of such patients may be possible in some homes but not in all homes. There are homes in which there is horrible overcrowding and there is need for the removal of advanced T.B. patients from such homes. If this is not done the disease is bound to spread further.

The Pingalwara was brought into being for what little could be done to save patients of different diseases from dying unattended on pavements of the roads. It may not be within the power of ordinary man to establish big indoor hospitals, but they can render physical assistance to sick persons so as to enable them to avail of whatever medical aid is available from the outdoor of the hospitals. It is a new experiment of medico-social welfare in the country and needs very close examination at the hands of research scholars and planners.

The mental patients and lunatics are also entitled to very close attention. Their plight is more miserable than that of the T.B. patients. They even murder people while roaming in the streets and sometimes set houses on fire. Patients of other diseases can individually go to the hospitals by themselves even if they have to be carried on stretches, but a lunatic person cannot go to Mental Hospital by himself. He has to be taken to a hospital by other people; their number varying according to his physical strength and the degree of his insanity. They are in need of constant watch and control so that they do not run away. At least two persons are needed for keeping watch over a lunatic person when he is being taken from his home to Mental Hospital or Mental Clinic situated far away from his home. It is not possible for every family to provide such assistance to their lunatic relatives. Some families are small, others are very poor and it is not possible for them to employ a servant for the care of their lunatic relatives. There are other difficulties. Some lunatics are unattached. How difficult it is to get them admitted in the Mental Hospital? Who should volunteer himself for getting an unattached mental patient admitted in a Mental Hospital. One has to go through a lengthy process of admission apart from taking care of them for a period of five or six months before their turn of admission comes. This necessitates an organized effort.

The treatment of lunacy is bound up with a time limit of three years, after which the disease becomes incurable. The chances of recovery of this disease in the first year are seventy to eighty percent, thirty to forty percent in the second year and only ten to twenty percent in the third year. It is very cruel if nothing is done by the community or the society in time for poor and unattached mental patients before their disease becomes incurable as a result of the lapse of tie.

A lunatic person should be looked upon not only as an economic liability to the nation but also as constituting a danger to people’s lives and property. Lunatic women can prove more harmful to society than men because they become victims of venereal diseases when they roam about the streets and open places unprotected by anybody under his personal care. Then there is further danger of the spread of the disease when once a woman gets infected with such diseases.

The Pingalwara is the only institution of its kind in Northern India doing this kind of work and has to bear the burden of the care of large number of patients who are converging to this institution from all parts of the State and from many other States. This aspect of the problem should open the eyes of the State Health Department and the Social Welfare Department not only for doing their best in this matter but also for devising other ways to arrange financial aid for the maintenance of the Pingalwara and also for solving its building problems. Unless similar institutions are opened in Chandigarh, Patiala and Ludhiana where the other three standard hospitals of the State are functioning all the needy people cannot get benefit from the outdoors of these hospitals. This is an imperative need which is long overdue and there is no reason why the State Government, apart from devising a scheme for the Pingalwara at Amritsar, should not develop this scheme at State Level.