My Return to India (R2I) story > R2I Chapter 10
Friends and colleagues living in the west often ask me about my observations on India, especially as seen through the lens of someone who spent most of his working life in the west before moving back. After all, like many first-generation immigrants, I too had got accustomed to the creature comforts in the west before exploring the next phase of my life in the rough and tumble of life ‘back home.’
The common topics of interest include crowding in public places,
pollution, corruption, bribery and navigating on crowded roads, traffic and
public transit. The pandemic also brought the state of public and private
healthcare to forefront.
My general refrain when asked about problems in India is to
quote Dickens – it is the best of times, and it is the worst of times.
India is certainly an overpopulated country and the density
of population is not merely an academic concept. The sheer population hits you
even before the aircraft begins to land at any Metropolis in India. One can see
densely packed urban sprawl even as the aircraft approaches any major airport
in the country, a far cry from the pristine greens or zoned housing one can see
as you are landing in any western airport.
The sense of crowding really hits home the moment you leave
the arrival lounge and take a cab ride out to the city.
The sheer volume of traffic and jams are just a
manifestation of the population. The growing affluence of the middle class also
means a lot more bikes, scooters and cars on the roads, increasing the traffic
density. You don’t really have to be an urban planner to see the unregulated
sprawl in front of your eyes.
While I had minimal commute during the first few months after relocating, the excruciating impact of traffic on daily life hit me when I began to commute to work in the pre-pandemic era.
Corruption and Bribery
Corruption in India is a topic of discussion among middle class and diaspora alike. In a way, this is also a manifestation over-population. Too many people chasing fewer resources and services.
A while ago, my Indian driving license was expiring and was
due for renewal. The government has been on a digitization drive and the Indian
Department of Motor vehicles has undergone a large scale computerization. One
can look up one’s driving license details online and request services like
forms for license renewal, which I did. However, some renewals also require a
medical fitness certificate.
I checked with my family doctor who explained that only
doctors in Government hospitals are authorized by the DMV to issue a fitness
certificate. Unlike my dad, I didn’t have an easy access to government
hospitals, and anyone who has been to one knows how overworked and stressed doctors
there are; not to mention the crowds and endless queue to meet a doctor. I was
cognizant of my time and didn’t want to spend the day running around the
labyrinth of a Government hospital for a fitness certificate.
Some people try to find “someone who knows someone” in a
government hospital. Needless to say, this is a complex chain of nepotism and
favor-ism with a chain of favors exchanged and obligations honored. The person
obliging you may eventually call you back on that favor at an opportune time.
There is another, simpler option for folks like me who
neither have the time or patience to run around or seek favors. Walk up to any
RTO or government office and outside the complex, you are bound to see scores
of “agents” operating kiosks and Xerox (photocopy shops are still called Xerox)
shops that offer instant photograph and notarization service. For a small fee,
the agent will get you a pre-filled doctor’s certificate complete with a sign
and signature. I decided to patronize an agent who printed a pack with the
doctor’s signature that I could present at the official RTO counter for
processing. He also offered a ‘premium’ service, at a huge markup, to actually
submit the forms and get my physical DL back the same day, which I declined.
One might argue that folks like me are encouraging an indirect form of corruption by patronizing an agent. Agents and officials alike recognize the fact that more individuals are not conversant in the intricacies in filling forms with required documents and addendums and may not have the inclination to ‘learn’ the process to file it right the first time. The same story seems to be playing out in government departments across the country:
- Are you planning to sell a vehicle and want the papers transferred?
- Do you wish to register a sale deed and ensure you have the required copies of documents, references and attestations?
- Do you wish to get an official copy of a death certificate?
- The list goes on
While the government is happy to recognize 1-percenters like
me with a silver certificate for the tax-contributions, I have absolutely no
standing when it comes to services. Patronizing
an agent seems to be the only prudent option for those who wish to stand the
high moral ground by not directly paying a bribe.
Healthcare in India
The healthcare system came under intense scrutiny during the
pandemic when images of patients gasping for oxygen in makeshift centers
outside government hospitals is seared in the minds of an entire generation.
The pandemic and travel restrictions also exposed the
fragility of our lives. During the peak of the first and second waves, I would
routinely get calls and messages from global colleagues asking about the
situation in India and from NRI friends asking about how they could support
parents and family living thousands of miles away back in India.
The Indian healthcare system is a study of contrasts – those
who can afford it can access world-class care in state-of-the-art hospitals
that also double up as “medical tourism” hubs that also attract clientele from
around the globe. At the other end of the spectrum are small government funded
clinics and health centers with barest of minimum ‘service’ to the crowding, needy
masses.
There is a vast network of government hospitals in metros,
districts and towns across the country in addition to the network of primary
health centers in rural villages and communities. Constrained by resources and
generally understaffed, these centers provide the barest minimum care, and the
centers are generally crowded and teeming with patients and caregivers.
In a previous section I talked about the Military Hospital
system, which is perhaps on par with the best that the global healthcare
systems can offer. This demonstrates how the government has the ability to
provide quality healthcare when required. At the same time the policy makers
realize that quality care will come at a cost, and there just aren’t enough
resources to provide such a healthcare for the 1.4 billion people – a large
majority of whom are below the ‘poverty line’ or work for informal sectors that
do not contribute to the tax economy.
On the other end of the spectrum are the large chain of
branded “five star” hospitals like the Apollo, Narayana, Columbia Asia, Baptist
and others with health centers in major metro cities that provide care in
air-conditioned comfort. Between the two extremes lie a vast array of private
hospitals and clinics that provide basic primary care at an affordable price to
the teeming middle-class.
About six months after we moved, Vijay began to exhibit
symptoms of allergies including irritation of the skin and runny nose. We went
to a local pediatrician who prescribed some antihistamines. After a second
visit, she referred us to an allergy specialist who recommended a course of
treatment that seemed to arrest the symptoms. The total cost of consulting and
the course of drugs was less than Rs 2,000 (about $30), which would be my
co-pay with the insurance plan back in Greensboro.
I realize that the above example illustrates a rather simple
scenario of medical care, and each situation is bound to be different. Based on
your family’s personal circumstances, you need to be prepared to bear the cost
of quality care.
This disparity between affordable care for the masses,
versus a pay-as-you-go system that middle class have designed for themselves
manifested itself during the pandemic.
I now work for a multinational that provides me a world
class insurance coverage in India. While the coverage is for hospitalizations,
most returning NRIs will have to factor in the cost of such an insurance plan
if they wish to have access to good medical care. Based on your personal
situation, you either should budget for medical care expenses out-of-pocket or
get adequate medical insurance coverage as appropriate.
eCommerce and delivery for life’s needs
The past decade has seen a huge growth in consumerism and
adoption of digital technologies in urban India. Affordable smartphones and
access to low-cost data plans have been a game changer for businesses and
consumers alike.
After moving back to India, I had to unlearn some of the
habits of consumerism I had imbibed during my stay in America. Likewise, I had
to untrain my parents on the traditional mode of shopping and acquiring
services. Simple habits like walking down to the local grocery store in lieu of
collating a list to place an online order are not easy to break, especially for
the elderly. However, after seeing the convenience of online ordering and the
promptness of delivery, coupled with pricing discounts, my parents began coming
around to the digital mode. The same goes for paying utility bills and even
showrooming for larger purchases like the fridge and TV we had to replace or
the RO water filter we had to get installed.
This is not an endorsement, but Amazon and Flipkart with its
wide array of vendors and the network of service providers has been
transformative for the Indian consumer. All this came to the fore during the
pandemic and lockdowns when local administration and communities wisely decided
to allow eCommerce services and delivery while most citizen were told to stay
at home.
The Indian government has also made great strides in
digitizing services. For instance, Bengaluru City council - the BBMP - has a rather useful mobile App called Sahaya
where one can place requests or complaints about specific services like garbage
collection and the service is tracked and addressed in rather prompt manner. In
the past couple of years, I have placed several online BBMP request, most of
which have been addressed in a span of a few days after local officials called
to confirm the service.
Consumerism and digital engagements have really advanced in
many segments across the market, but the ‘customer service’ mindset and
customer satisfaction still has miles to go. Case in point is a claim by a
“social media influencer” who posted a video with a bloody nose that she was
‘punched’ by a Zomato delivery guy. After the video went viral, a CCTV video
showed that she had bloodied her nose herself to falsely accuse the poor
delivery guy. Turns out that he was
about 10 minutes late and she was trying to delay him by another five minutes
to claim a ‘free delivery!’
What does all this mean to you?
If you are planning to return to India, you should do so
with your eyes wide open. Some social issues like corruption, bribery and
traffic jams and crowded services that you left behind are still prevalent. You
will have to re-learn to navigate the system.
Digitization of services are helping common-man and you
still have choices. You can opt to be an idealist and stand in a queue for
basic services or ‘outsource’ it to agents and middlemen.
Depending on your individual and family situation, you will also have to pay attention to healthcare services, which are largely market driven but affordable by global standards.
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