India's healthcare visionary treats familiar complaints

World-beating aspirations and Third World pay. Peter Popham on Delhi's shiny, 'good as the West' hospital

"WHAT I say to the government is, look at health care as an industry like any other," says Dr Prathap C Reddy. "If the country has a surplus of wheat, you export it. If you have a shortfall, you must import. But you can't export the sick. So what's needed is to get foreigners to invest."

Dr Reddy, chairman of the Apollo Hospitals Group, is in the early stages of bringing about a revolution in the Indian health care system. His newest hospital in Delhi, opened 18 months ago, is enormous (700 beds), slick, sparkling clean and better equipped than all but the very best hospitals in Britain. Staffed by 200 consultants, 100 of whom are Indians that Dr Reddy headhunted from the NHS, it offers the most advanced treatments in the world - an X-knife machine in Neurosurgery, for example, for treating brain tumours without invasive surgery - for as little as a tenth the cost of the same treatments in the US.

Dr Reddy can afford to do this because, while his consultants - all of whom, American style, are private practitioners within the hospital - earn about half what they got in Britain, nurses and other staff are paid the typical Indian pittance. So a staff nurse gets pounds 65 a month, a ward orderly only pounds 25 and casual staff pounds 1 per day.

But the contradictions between Apollo's world-beating aspirations and its Third World pay packets have exploded into conflict, bringing the place to a standstill. Last Sunday, two workers in housekeeping were suspended for sleeping while on duty, and overnight 1,500 of the 2,000 staff came out in protest. They stayed out until Friday, several hundred of them camping outside the high iron gates under canopies against the hot sun. "APOLLO MANAGEMENT, WHAT A NICE!!" read one of their placards. "PATIENTS INSIDE, WHOLE STAFF OUTSIDE!!!"

Delhi's Apollo has been controversial since its inception. The land it stands on, in a desolate-looking but affluent section of southern Delhi, was sold to the company by the city government for next to nothing on condition that the hospital catered to the poor as well as the rich. That remains the long-term intention. But the hospital that rose on the site was startlingly ostentatious.

There is a strong whiff of American postmodernism about the chunkily expressive facade, the high, barrel-vaulted ambulatory between the two wings, the broad pavement inlaid with beautifully coloured granite. The reception areas are cool, clean and generous, the private rooms comfortable and modern. Everything about the place oozes refinement and distinction.

But last week it quickly began to take on a more normal Indian aspect as rubbish accumulated, lights failed and were not replaced, and streaks of betel juice appeared on the stairways. Outside, nurses and lab technicians talked bitterly of long hours, bad pay and arbitrary promotions. Inside, senior consultants moped around the grubby, unpeopled spaces and asked each other how much longer the dispute could go on.

On Thursday night something snapped. The hunger, the heat and the lack of water or sanitation for the picketing strikers may have had a lot to do with it. At a meeting with Dr Reddy inside the hospital, they agreed unconditionally to return.

Dr Reddy's explanation for the change of heart bordered on the mystical: "The Apollo is never governed by rules - it is governed by l-o-v-e. I didn't accept any of the strikers' demands... I said to them, let's re- establish the path of love that has become slightly derailed. The people who were suspended kissed me and touched my feet. This hospital is a family."

Dr Reddy is only the latest of a long line of Indians in this century - Gandhi and Nehru being the most famous - who have attempted to change India in the light of what they have learned abroad. He practised successfully as a cardiologist in the US before returning to India in 1971, where he set up in his home city of Madras.

"One young patient of mine needed a coronary bypass, which could not be performed in India," he recalls. "The cost in the US was $30,000, but his company refused to pay, and the young man died in front of my eyes. I pledged I would never let this happen again. My driving force has been: if Indian doctors abroad are as good as the locals, why can't they do it back home?"

He built the first Apollo in Madras. "To do anything in India for the first time is not easy," he says. "That hospital had a million bricks and a million problems." Since then, however, the business has prospered.

Dr Reddy insists, however, that it is much more than just a business. "Our mission is to bring an international level of care to a cross-section of Indian people. There is a tremendous gap here between supply and demand. There is only one bed for 1,300 people, compared to one for 250 people in the West. To begin to bridge the gap - to increase the provision to one bed for 750 people - will take an investment of $7bn per annum for seven years. The government realises it's a mega problem, and that they don't have the billions to invest. There's no alternative to involving the private sector."

No one disputes that Indian health care is in need of a drastic shake- up. The present system offers a parody of universal provision, with many hospitals so filthy and ill-equipped that they hardly function at all. Until the advent of the Apollo, the alternative for the rich was to go abroad.

Dr Reddy dreams of the day when a reformed insurance sector will enable 300 million middle class Indians to become his customers. But as the grievances of his "family" makes plain, struggling to get by on pounds 25 a month, a million more problems must be solved before the dream comes true.