In a modern nation’s collective consciousness, its Independence Day is an uplifting landmark. Especially when it has involved overthrowing a powerful colonial power through a long struggle. It is a time for celebration, nostalgia and shared pride. But as the nation matures, it could also be a juncture to take stock of where we are. And even raise uncomfortable questions.
Colonial powers pillaged their colonies for their own benefit, the fruits of which they still enjoy. This involved brute force and abuse. It set back human progress for the natives in more ways than one. For example, the health of the citizens of the colonies was abysmally poor compared to the Western rulers. So, was the spread of the global scientific revolution facilitated when European colonisers, with a head start in science, ruled countries in the global south? Did the advances of Western medicine help improve the health of the rest of the world serendipitously through colonialism?
The British brought Western medicine to India. The primary motive was to look after their own health needs. For this, they needed to build robust institutions, organise a healthcare system and train locals. They had to tame the local traditional systems and healers. In public health endeavours like vaccination, they had to overcome resistance from local cultures. But they realised that if they had to rule for long they needed to look after the health of the ruled.
The history of healthcare in British Bombay is an interesting case study. In its early years, it was clearly demarcated for the rulers, who were served by their own doctors, and natives, who were treated by traditional healers. But the British soon embarked on setting up institutions of research, training and treatment in Western medicine. In 1845, the Grant Medical College in Byculla was one of the earliest medical colleges established by the British in India. The Jamshetjee Jeejebhoy (JJ) hospital was built with a donation by a Parsi merchant. Later the Gokuldas Tejpal, Cama and St George’s Hospitals were brought under its wings. Though Grant Medical College was meant to serve locals, only Britishers could be appointed on the staff for many years. In response to this and as a part of the rising nationalist tide, other institutions came up. The Gordhandas Sunderdas Medical College and its affiliated King Edward Memorial Hospital was setup in 1926 through a citizens’ initiative and a donation by the heirs of a wealthy cloth merchant. A National Medical College had been setup in 1921 near Bombay Central with a People’s Free Hospital with it. Dr AL Nair, proprietor of a company selling medical equipment donated two acres for a hospital campus in 1925 in memory of his mother. MN Desai, a businessman popularly known as Topiwala, paid for the hospital’s expansion. This later became the Topiwala National Medical College and Nair Hospital.
The British also set up institutions addressing public health challenges. Waldemar Haffkine was assigned to set up a ‘Plague Research Laboratory’ in 1899 where he did pioneering work on cholera and plague vaccines. The Institute was renamed the Haffkine Institute in 1925 and is in the campus of the then Governor’s residence in Parel. The Kasturba Hospital for infectious diseases was set up as a plague hospital in 1892.
Healthcare in Bombay thus largely grew through a combination of British initiatives as well as philanthropic contributions from well to do Parsi and other emerging trading communities of the city. Some of the local doctors helped by their proximity to the British travelled to England for higher medical education. They brought with them British ideas, methods, mannerisms and even the dress. They wore suits and ties on hospital rounds and insisted on everyone speaking propah English. Their patients – ordinary Indians – were bewildered and intimidated.
Meanwhile, back in post-world war Britain, the Labour party was elected to power with Clement Attlee defeating Winston Churchill. Attlee’s socialist health minister Aneuryn Bevan set up a blueprint of a tax-funded universal healthcare system providing medical care free at point-of-need across the UK, regardless of wealth. Despite resistance from opposition parties and the British Medical Association, the National Health Service was launched in1948, nationalising more than 2,500 hospitals. Thus began the NHS which still serves all British people. It was under Attlee that India had also obtained independence. The British set up a committee led by Joseph Bhore to provide a plan for independent India’s healthcare policy. The Bhore Committee suggested a NHS-like healthcare system for India. This never happened. In one of the most intriguing deviations of policy-making in post-independence India, what we now have instead is the world’s most privatised health care.
Mumbai and other Indian cities now boast of several large hospitals providing advanced healthcare on par with the rest of the world. But largely for those who can afford it. When the British left India we inherited their ideas of Western medicine, medical education and institutions. Why did we not inherit the idea of a National Health Service? The explanations perhaps lie outside the scope of linear history. Maybe in India’s strong social hierarchies. Maybe in philanthropy of the elite being mistaken for genuine social solidarity. But it’s a fair question even on our 75th independence day. After all, independence is about the well-being of all our people.
Sanjay Nagral is a practicing surgeon in Mumbai.