Field Notes: Getting A Story Bottom-Up Instead of Top-Down


“How can you go around the hospital speaking to people? I have only given you permission to speak to Dr Patel.”

That was Dr Rakesh Joshi, superintendent of the Ahmedabad Civil Hospital, talking to me in June 2023. He was clearly not happy.

I was visiting the hospital to do a story (here) on the Prime Minister’s health insurance programme or, to use its official name, the Pradhan Mantri Jan Arogya Yojana (PMJAY), which was launched in 2018 to prevent “catastrophic” health expenditure that pushes about 60 million Indians into poverty every year. 

In September 2022, the government claimed the programme had saved “crores of families” from poverty, but there were no data to support this claim, and studies (here, here and here) indicated that the poorest Indians—for whom it was primarily meant—were not benefitting.

There was no better place to report the story than from the Prime Minister’s home state, the administration of which for years had been touted as being among the best in India, what Narendra Modi called “the Gujarat model” of governance. I currently live in the state’s largest city, so I zeroed in on the largest government hospital in Ahmedabad.

As a health journalist, I know that navigating government hospitals, especially in cities, is not an easy task. There are often security guards who stop you from speaking to patients and doctors, and I suppose this is understandable because these hospitals are not exactly paragons of administrative or medical efficiency. Those who come here do so mainly because they cannot afford to go elsewhere. It is, of course, true that many government hospitals have very well-qualified doctors, staff and equipment, but on the whole, they do not welcome scrutiny.

I expected a smoother run at the Ahmedabad Civil Hospital since I had met Dr Joshi, and he had given me permission to meet Dr Rajesh Patel, the PMJAY nodal officer, and patients enrolled in the programme.

But the moment I went to the women and child hospital and took a photo of the PMJAY counter, a swarm of security personnel descended on me, asking why I had come there and what I thought I was doing. When I told them that I had permission to speak to patients, they remained suspicious and wanted to double-check with the superintendent.

The guards told me to return to the main hospital, about 800 m away and get permission again. When I met Dr. Joshi again, he was irritated. "How can you go around the hospital speaking to people?” he said. “I have only given you permission to speak to Dr Patel. If he has given you a list of patients who have enrolled under PMJAY, then you can speak to them.”

This made little sense to me. How could I possibly gauge that patients had complaints if I was to meet only those vetted by the hospital authorities? It was hard to imagine that patients would speak freely under the gaze of security cameras and security guards. I had gone to the women and child hospital to escape their scrutiny. The few patients I managed to speak to before I was stopped had not enrolled for the PMJAY, were not interested in it or did not know about it. 

I was sure that I would face the same difficulty in speaking to patients in other public hospitals in the city, so I decided to switch my reporting from top-down to bottom-up: I went to the homes of people who were supposed to be using the prime ministerial programme.

I zeroed in on a low-income neighbourhood called Vastrapur, where my domestic help lived. She said she could introduce me to her neighbours. It was here, during a downpour, that I met Pravinbhai Ghariyal, a 46-year-old housekeeper in his one-bedroom home, littered with buckets to catch water from his leaky roof.

It was people like Ghariyal that the programme was supposed to benefit. His housekeeping job was once enough to provide for his wife, mother and four children. That was until his wife suffered a stroke in 2021. He spent Rs 300,000 for the few days that his wife spent at a private hospital. It was enough to plunge the family into poverty.

Today, even though his son has joined him in the housekeeping business, they can barely cope. He can barely service the monthly interest of Rs 5,000 towards the loan he took from a local moneylender, who has now waived the interest, but Ghariyal has no idea how he will pay the principal amount. Daily living is difficult, and he makes up his deficit through the generosity of others, from neighbours to his manager.

The medical expenses continued since the stroke left his wife debilitated. Ghariyal should be an ideal candidate to get some relief from the PMJAY programme but to be eligible, he has to have a below-poverty-line card, which he doesn’t have because he is technically above the poverty line. That he was not a PMJAY beneficiary indicates the programme's infirmities, which, as I said, many studies have confirmed. 

As a reporter, I was satisfied that I met Ghariyal. I got the story, but I did not feel very happy about what I had got. 

You can read the full story here.

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