Better Health For All

By Andy Beckingham

If you’re going to work in public health in India, a laid-back attitude helps. Can you accept that it’s you who must fit into a very different system, and not India that should follow the NHS?

UK training and our island culture instil a moral certainty, and working in India will reveal that to you. Uncomfortably.

For years I worked in the NHS, where there’s a structure and a process for EVERYTHING. That structure makes me feel safe – I could always find a PCT website with a downloadable policy for anything.

We grumble about the NHS, but forget how reassuring it is to have a familiar set of ‘rules’. In India, when I can’t find the ‘rules’, my automatic reaction is: “Oh god, there’s no system, it’s chaos…” It’s not true, of course. There is a system. A different one. It just takes me a few minutes to remember that, and stop ‘splitting’.

If you try to handle your uncertainty by transplanting ideas from the NHS, they may be rejected, because they won’t fit. What India needs is home-grown, sustainable public health. They can write their own guidelines if they need them. Nearly everyone I work with here is better qualified than I am. India doesn’t need ‘experts’ from the UK. The most valuable contributions you might make are the same ones that someone from India might make to a UK public health department – personal qualities, different experience and new approaches to team working.

In India, it will take you months to learn how the public health system operates. You will be tempted to see it as slow and bureaucratic. No. It’s just complex (like the NHS is complex) and embedded in a social system very different to that in the UK. I am often struck by how ordered and ‘Germanic’ the UK, and especially the NHS, now seems. India’s much more like Southern Italy in this respect (but sadly without the espresso and the red wine).

I suppose the moral of my little diatribe is that working in public health in India requires tolerance. Can you tolerate uncertainty? Can you tolerate feeling vulnerable and inept? Can you tolerate dirt and dust, and spending time alone? If not, Indian public health is not for you.