Thread by @netshrink

THREAD: My personal experience working in India's public health system.
Regular readers of this timeline will know I am a supporter of a public healthcare system.
So naturally I get asked, why don't you work in the public health system, if you think it is so good?
Here's why ++

I trained in a public medical school Seth GS Medical College & KEM Hospital 1982-91 & left in 1991 to go to UK having completed a MD (Psychiatry).
I worked in the NHS in UK from 1991-1999, when I returned to India.
During my time in UK, I got to see first hand & closely ++

what a treasure the NHS is. From the millionaire to the homeless, everyone got the same treatment - free of cost at point of delivery & based on medical need. The primary care GP system was amazing. Anyway, I was determined that when I return to India, I would ++

work only in the public health system.
A yr before my return I had looked for opportunities to work in Pune & the Psychiatry Dept at Sasson Hospital (it had become an independent Maharashtra Institute of Mental Health) was very supportive & promised me a job. Also promised I ++

could continue my research incl bringing over my grants from UK.
It all seemed perfect. I quit my job in UK & came back to India in summer of 1999
When I joined Sasson/MIMH, I was told there was a problem. The job I was promised was not available as it was stuck in some ++

bureaucracy which I was promised would be sorted. I was offered a temporary post with a 11 month contract with a promise that a permanent job would be advertised & I could apply for it in 6 months max. I had no reason to doubt any of these promises. I threw myself into work ++

My salary in UK was an obscene amount £3k and I was now getting a princely salary of ₹7000. I wasn't really bothered bcoz privilege meant I had a large house, no loans, my kid was only 3 yrs old. I was looking forward to resuming research + enjoying teaching post graduates++

I also took to travelling by public transport and to avoid the crowds would land up at work at 7.30 am & leave only at 7.30 pm or later.
The work was initially satisfying. But as time went on, I realised that any change I wanted to make was blocked. +++

They had a problem for every solution. I had got a research grant from UK. I was told this needed special permission from the state Health Secretary. My UK collaborator (a Prof) had to be present so he flew down. We were given an appointment to see the Secretary @ Mantralaya ++

in Mumbai at 10 am. Drove down early from Pune. We were kept waiting till 5 pm, then finally seen for 5 min & the Secretary said put in a proposal & he will see. I didn't understand this bcoz I had already put the proposal. Found out months later, the office had ++

never forwarded this to the Secretary's office as the Institute Director had just sat on it.
Anyway, 6 months in the job, there was no sign of the permanent job & I was told not to worry, it will come through.
Another 3 months (by then I was a bit desperate) I was told ++

the permanent job was not being advertised as the Govt had frozen all recruitments. The Director offered me another 3 month extension, and a promise that a 11 month extension was in the pipeline.
At 10 months when I went to collect the 3 month extension, I was given a 28 day

extension with a promise that it would be extended every 28 days with a 2 day break. On asking, the Director made some excuses & gave her personal promise to get it sorted.
In that 28 day period, I fell ill for 2-3 days with flu.i did call up the Director & inform her ++

When I returned to work after 3 days, the Office Superintendent served me a show cause notice for being absent without leave. I protested to the Director who said not to worry, this is just routine practice & I should just write a reply within 15 days.
3 days later ++

was payday & I found they had docked 3 days salary from the princely ₹7000 (for being absent, apparently temporary staff were not entitled to sick leave).
I put in my resignation that day. I knew I was not wanted there. Walked out of there that evening & have never set foot +++

in that place to this day.
I ended up getting depressed & not working for next 6 months (but that is another story). I lost the UK funded research grant as there was no institution where it could be based.
My UK Prof said I should come back to UK. I was unwilling to go back ++

as a failure. So decided to stick it out here.
Anyway, I did try for another job which was advertised at another medical College in Pune, but I was not selected. I didn't have the right 'connections' apparently & I did not have sufficient experience (they refused to recognise++

my 10 yr UK experience).
So this is why don't work in the public health system - not for want of trying.
Despite this, I do believe that India needs a publicly funded & publicly provided healthcare system free at the point of delivery.
The millionaire and the pauper should ..++

get equal healthcare based on medical need.
The public health system is full of dedicated health professionals who have more ability & tenacity than me to brave out the challenges. They do a fantastic job under difficult circumstances. END.