India–Dec 2024

I visited New Delhi, India to see family from Dec 17 – 26th. I flew Swiss air with a connection in Zurich on the way there, and a direct Air India flight on the way back.

There were several reasons to celebrate on this trip. My family just sold the house in Haridwar, a town along the Ganges where I grew up. My parents continued to live in the house for a few more years after I moved out to attend college in Bombay. Around 2005, my dad was transferred to New Delhi and had to move. They bought an apartment near New Delhi and have lived there ever since. Ever resourceful, they found someone to take care of the house in Haridwar in their absence and started renting it out.. this arrangement worked for almost 2 decades, but recently had become increasingly difficult for my parents to manage. The area where the house is located has grown tremendously in the last 2 decades, with many companies setting up and people moving in. When I visited the town a few years ago, it had changed so much that it was difficult to find my bearings. Unfortunately, as happens so often in India, the development is very haphazard, and much of the small town charm of my hometown is irretrievably lost.. However, as a result of all that development, land prices have grown considerably, and my parents were able to get a very good price for the house, from a trusted buyer. I have so many fond childhood memories from growing up in the house, so the sale was a bit bittersweet, but also an inevitability. My dad also turned 75, a big milestone for someone who was only given a few years to live when he suffered two heart attacks in his 30’s resulting in loss of significant cardiac capacity, and underwent triple bypass surgery.

As we do every year on my dad’s birthday, we organized a “pooja” (Hindi for “worship”), where a priest performs a religious ceremony that involves chanting “mantras” and casting offerings in a small fire to propitiate various gods and invite their blessings.

To celebrate and spend some family time together, we had planned to visit Jim Corbett National Park, a popular ecotourism destination in Northern India, that is home to extensive flora and fauna, including Indian elephant, Indian leopard, Bengal tiger, Asiatic black bear etc. However, a day before the trip, a close family member was diagnosed with Stage 0 breast cancer. The news shocked us all and we immediately cancelled the trip to the park. The next few days were spent shuttling across various hospitals in Delhi.

Having moved out of India around age 21, my experience with the Indian medical system was limited. Besides routine medical care, I had once been briefly hospitalized in my hometown to address a persistent strep infection.. and that was it. Indian medical care has traditionally been dominated by hospitals and dispensaries owned/managed either by the national government or by large quasi-state companies, such as BHEL (Bharat Heavy Electricals Limited), a huge electricity generation equipment manufacturing company, where my dad used to work. These hospitals tend to be slow, bureaucratic and lumbering, although there are some pockets of excellence, such as AIIMS (All India Institute of Medical Sciences) that train some of the best doctors in the world, conduct quality medical research and provide top notch care.

In the 80s, to address the unmet medical needs of a vast population, the government finally allowed private ownership of hospitals. Apollo hospitals in Chennai, where my dad received his bypass surgery was an early pioneer. There has been no turning back and private hospitals have seen tremendous growth. According to this wikipedia article, the private medical sector is now the primary source of health care for 70% of households in urban areas.

I accompanied my relatives to two hospitals in New Delhi–Max and Medanta in Gurgaon, a suburb of New Delhi. We were able to get appointments with top oncologists at both hospitals, thanks to family contacts. I don’t know how long wait times would have been without those contacts. I noticed some significant differences between medical care in the US vs. India. In the US, care is better integrated and the patient is billed for care afterwards, not while at the hospital. This can often result in a nasty surprise in the form of unexpected medical bills from multiple providers (radiologists, pathology labs etc), but lowers the amount of stress and running around required while at the hospital.

From what I experienced, medical care in India is more disconnected and disorganized. The first oncologist we saw prescribed a range of scans, tests and biopsies. This prescription was handwritten on a piece of paper, without any digital record. When we arrived at Max with this piece of paper, we first had to pay for each procedure and then proceed to the relevant section of the hospital with the receipt to receive care. We had to repeat this process for every procedure listed on the doctor’s prescription. One of the procedures (a MRI guided biopsy) wasn’t available at Max, and the relevant doctor (who we knew personally) obtained an appointment with a doctor at Medanta, who offered that procedure. We then drove to Medanta to get this procedure done. Some of the procedures required blood tests, which had to be repeated, because one hospital wouldn’t accept the results of tests conducted at another. After all of this, we were responsible for collecting all the reports/results, and present them before the oncologist, who recommended the next steps.

You rarely get anything in India by politely waiting for your turn. This was true at the cashier’s desk as well. There were several people hovering over the cashier, and some pushiness and sharp elbows were required (and accepted without push back) to get the cashier’s attention. The medical staff we encountered were generally kind, helpful and professional. Couple of times when I got lost, a medical staff passing by proactively asked if I needed help and pointed me the way to go. There was a lot of paper involved..paper receipts had to be presented everywhere. I came to know later that there is an online patient portal, where the results of all the procedures are eventually made available.

These inconveniences aside, the quality of care we received was top notch. This is partly a result of the extensive clinical experience doctors in India accumulate as they see a huge variety of patients, diseases and outcomes, combined with availability of high quality medical equipment. The hospitals can afford to make these investments, because a rapidly expanding middle class growing in numbers and affluence can afford to pay for it. Still, private medical care in India, while expensive relative to the average income, is a fraction of what it costs in the US and Europe. No wonder that India is a popular medical tourism destination!

Connections and some level of wealth matter a lot in India. We were able to receive timely and good quality medical care, thanks to family connections.

Few other observations.. the air quality in Delhi continues to be atrocious. Every time I go back to India, I have a glimmer of hope that perhaps this time it would be different.. but those hopes are dashed even while the plane is in the air and about to land, and yet no city lights are visible because they are smothered in smog.. air quality is particularly poor in winter months, when to clear the fields for the next crop, farmers in neighboring areas burn rice stubble after harvest, releasing large amounts of harmful particulate matter into the atmosphere. Prevailing wind patterns drive this matter over Delhi, leading to severe smog.

On the plus side, traffic seemed a bit more orderly, with more vehicles following lanes and obeying traffic laws. Traffic congestion though seemed as bad as before, covering the ~25 Km from the airport to my parent’s apartment in Delhi’s suburbs took > 2 hrs. Incessant honking also continues to a problem..

On my last visit, I had spotted a few electric rickshaws. I was very happy to see that their ranks had swelled. We took several electric rickshaw rides to visit a nearby mall. Their continued adoption could make a small dent in lowering vehicular emissions and improving air quality!

Every time I visit India, I come back impressed and inspired by the industry and resourcefulness of its people. So many people from poor family and educational backgrounds come to big cities and make a living running small businesses such as laundry/ironing stations, selling fruits/vegetables, phone accessories etc., and providing household services such as cooking/cleaning etc. Most of the small businesses are unregulated and operate out of small roadside shacks on a street corner where a person used to affluent living would find difficult to stand for more than a few minutes because of the noise, pollution and smell. And yet, the small business owner gets up early and travels long distances, toils long hours, manages a supply chain, supports a family and provides useful services to their customers at competitive prices. It is no wonder that the Indian economy has taken off since the 1990’s when the government finally let the brakes off private industry and lowered regulations.

For those of us living a life of relative luxury in the west or in India, it is a good reminder how hard people work with respect and dignity to earn even a little bit of money!

I also got to see Dipti, and old friend from middle school who is a doctor and lives in New Delhi with her family. I last saw Dipti when I was around 20. We had a great time reminiscing about old times at Readers Cafe, a lovely cafe and bookstore near my parent’s home. Dipti updated me on what our childhood school friends have been up to. We’ll try to organize a group dinner next time I’m in New Delhi. Can’t wait!

There is a new book out called “The Golden Road” by one of my favorite historians William Dalrymple, a Scottish writer and podcaster who has lived in New Delhi for many years. The book discusses how India’s ideas and influences spread throughout Central and East Asia and China during the Roman empire and early middle ages. The book isn’t out in the US yet, but I was able to find a copy at a local bookseller. Ever wonder why the main airport in Bangkok called “Suvarnbhumi” (“land of gold” in Sanskrit), or the national airlines of Indonesia called “Garuda” (large bird in Sanskrit)? You’ll find out why in this book!

Shortly before landing at JFK, I was greeted with this gorgeous sunset..