We incarnate the global division of labour: private clinics in India cooperate with NHS hospitals in the UK in order to reduce ‘waiting-lists’, labs in Gurgaon process material for the medical complex in the US, patients fly in for final operation in Gurgaon due to lower local costs, organ trade is the scandalised warehouse of this boom sector. While the public focuses on price comparison for services of expert doctors, they often neglect the low-wage service regime, which provides the material foundation for the hospital complex. A general overview and two reports by workers from the Medical Industrial Complex.
Medical tourism and global outsourcing of medical services (laboratory services, telemedicine etc.) is one of the few remaining boom sectors. On the bases of new technologies, oversupply of skilled labour in the global south, relatively cheap transport costs and dismantling of ‘public health services’ in the global north, we can see the establishment of a ‘global body’, which is worked upon in an international division of labour. According to mainstream statistics medical tourism to India has witnessed an annual growth rate of 20 to 30 per cent during the last years. Treatment costs for, e.g. hip replacement or heart surgery are said to be 20 per cent of the costs compared to US standards. The medical tourism business in Asia has grown to 4 billion US Dollar. Not only patients from ‘the north’ but upper-class patience from the Gulf countries, Pakistan, Bangladesh etc. come to India for treatment. Gurgaon has become one of the centres for medical tourism in India. Direct international flights to the nearby Delhi airport, special medical visa service, a sophisticated local service sector are the necessary infrastructural back-bone for an assembly-line type of industry: in Apollo hospital in Delhi doctors performed 4,200 heart operations in 2010. Critical voices point out that a lot of the ‘experts’ have been trained by public sector institutions, but now provide treatment for upper-class patients in private hospitals. While the working class – particularly in rural areas – face a lack of medical support, the material and labour forces are concentrated in the profitable ‘upper-class’ medical complex.
One of the centres of local medical industrial complex is Medanta Medicity, according to company website “one of India’s largest multi-super specialty institutes located in Gurgaon”. Spread across 43 acres, the institute includes a research center, medical and nursing school, 45 operation theatres catering to over 20 specialties. We met a housekeeping worker employed at The Medicity.
Medanta / The Medicity Worker
(Jharsa Road, Rajiv Chowk)
The building has four underground floors, it is 16 floors high and has 1250 beds. The housekeeping workers, general duty assistants, security guards, drivers, barbers, washing workers are all hired through contractor. They say that housekeeping is done in three 8 hours shifts, but most housekeeping workers work 16 hours shifts, they receive 4,348 Rs per month, their overtime is paid at single rate. The general duty assistants and the security guards work two 12 hours shifts. There are about 500 general duty assistants – they are paid 7,500 Rs for 30 days of 12 hours shifts. There are two canteens – the workers hired through contractor have a hard time there. For 20 Rs you get hardly enough to fill your stomach. Even if you work 12 hours shifts you won’t get a free cup of tea. The doctors, technicians and nurses are hired directly by the company. The nurses are paid 14,000 Rs, the technicians 22,000 Rs and the junior doctors get 50,000 Rs. They work on two 6-hours day shifts and one 12 hour night-shift. One nurse cares for three patients during a shift. The patient fees for a single-room is 5,000 Rs a day, for a double-room 3,000 Rs.
Down the supply-chain works a friend, manufacturing medical equipment. We regularly report about conditions and struggles of his co-workers at Eastern Medikit, casual workers occupied their factory some years ago in order to enforce payment of outstanding wages.
Harsurya Healthcare Worker
(110 Udyog Vihar Phase 4)
Around 900 workers manufacture IV syringes. We are paid single rate for overtime. Due to the high production targets there are a lot of accidents with the syringes. We are supposed to quickly tape the wounds and go back to the machines. You can only go to the toilet twice during a 12 hours shift and you have to fill in a register for that. If you need longer than 5 minutes you have to face being told off. In the canteen there is not enough space for sitting down during meal time. It is near to impossible to finish your meal during the 30 minutes, and you are told off if you are 2 minutes late. They have installed cameras everywhere. Wages are paid late. In order to overcome these problems a union has been formed three month ago. Since then management swears less at workers, but the company casual workers have been degraded and are now hired through contractor. Before you sign your new work-contract with the contractor he forces you to sign your notice letter – for the future. The union president has spoken out against this, so on 11th of December he was suspended. Since then production has come down and the company started to kick out workers bit by bit. The company has also put up two guys with rifles at the factory gate.