A healthy, helping hand?

The inauguration of the dialysis units at The B. D. Petit Parsee General Hospital (PGH) and Masina Hospital in February and March this year served to remind us of the growing need for health care facilities in the community in particular and society in general. As the life expectancy for Parsis in India increases, they become more and more dependent on modern medical advances to keep them able and alive. Aside from hospital beds, critical care facilities, sophisticated diagnostic equipment and qualified, trained staff are essential.

As the world population ages, health care is set to become even more of a subject of media focus. The popular daily mid-day carries a fortnightly column by Dr Mazda Turel, a neurosurgeon, on the hazards that spinal and brain illnesses entail. Jam-e-Jamshed features the occasional column by both Turel and histopathologist Dr Roshan Chinoy on medical matters. General articles on health, diet and exercise were and are staple editorial fare; specialized medical topics are now gaining favor.

"The number of beds per people is an important indicator of the health care system of a country," states Wikipedia. And community, we may add. Thus people were aghast when a small group of dissenters successfully blocked the creation of a cosmopolitan hospital to subsidize the loss-making, Parsi-only, charitable PGH. A Hong Kong based donor had offered to fund the project. In a country, and populous city, where hospital beds are a scarce commodity, this objection was sacrilegious (India has 0.5 beds per 1,000 population as versus three required as per the World Health Organization specifications).

The charges for commercial hospital beds are beyond the means of most middle class families. Insurance premiums are high and the amount insured capped depending on a person’s age and existing ailments. Medical expenses can impoverish a family, if not bankrupt it. Parsis end up knocking at the doors of several trusts for assistance.

In the financial year 2020-2021, PGH provided 325 patients free treatment while 210 were subsidized, stated PGH president Homa Petit in an email to Parsiana dated March 22, 2022. From April till December 31, 2021, 358 free patients and 241 subsidized patients were treated.

"During the financial year 2020-2021 and 2021 till now, we have spent Rs 2.47 crore (USD 323,354) and Rs 3.35 crore (USD 438,557) on free patients and Rs 1.71 crore (USD 223,860) and Rs 1.51 crore (USD 197,678) on subsidized patients. Expenditures on outpatients were Rs 0.60 crore (USD 78,547) and Rs 1.77 crore (USD 231,715) during this period... A CT scan machine and dialysis unit… have been largely covered by the donations received from abroad during these two years of the pandemic," wrote Petit.

Masina was fortunate to receive a donation from the Shapoorji Pallonji family and group of companies for their new, 14-bed dialysis unit (see "Masina’s high end services," pg 19). PGH has been the beneficiary of several overseas donors from Hong Kong, the USA and the UK, not to mention Zoroastrians from India. Their new, two-bed dialysis unit was funded by the Zarin Neville Sarkari Trust Foundation – Denver, USA, founded by US based Neville Sarkari in memory of his wife who succumbed to cancer a decade earlier (see "PGH dialysis facility," Events and Personalities, Parsiana, March 7-20, 2022).

Neville has also "committed an amount of USD 300,000 (Rs 2.3 crores) of which USD 200,000 (Rs 1.52 crores) has been received and the balance is expected later this month" to The Dorabji Nanabhoy Mehta Sarvajanik Hospital in Navsari, notes Dinshaw Tamboly who is the honorary treasurer and trustee of the institution. In addition Neville has pledged Rs 25,00,000 (USD 32,728) for the "Poor Parsi Patients Relief Fund," notes Tamboly. Though it is a cosmopolitan Hospital, "deserving Parsi patients get the benefit of treatment at concessional rates," states their advertisement in the March 7-20, 2022 issue of Parsiana. The Hospital provided over half a crore of rupees towards medical relief for the poor.

The Ruttanji Faramji Daboo Parsi General Hospital, also in Navsari, spent Rs 2,10,00,000 (USD 274,916) "for medical relief to poor and middle class Parsis in the year 2020-2021, including Rs 55,00,000 (USD 72,002) for Covid patients," stated their advertisement in the same issue. Their donations are received from within the country as they do not have the Foreign Contribution Regulation Act (FCRA) registration that permits an Indian trust to receive donations from overseas.

The Surat Parsi Panchayat’s Parsi-only, Seth R. D. Tarachand General Hospital is examining the option of turning cosmopolitan. As currently Parsi patients are few, the income and usage will not justify large investments in advanced medical facilities or personnel.

"It is obligatory for all charitable hospitals to provide two percent of their revenue for free and concessional rates to those who qualify as indigent patients," says Masina trustee Jimmy Parakh. "This is generally paid from our own funds." Occasionally they receive funds for burns patients and from WZO (World Zoroastrian Organisation) Trust Funds (WZOTF) for subsidizing Parsi patients, he notes.

The Bombay Parsi Punchayet that is undergoing a financial crunch spent a paltry eight lakh rupees on medical assistance in 2021-2022.

Hanging like a sword over the heads of these institutions is the draconian FCRA certification that determines whether they qualify for foreign donations or not. The government views nearly all overseas donations to Indian nongovernmental organizations (NGOs) with suspicion and makes the accreditation process exceedingly convoluted. The WZOTF receives "one hundred percent of its funding from overseas," says the chairman and managing trustee, Tamboly. "Of which around 70% comes from Hong Kong, 20% from FEZANA (Federation of Zoroastrian Associations of North America) and the balance 10% from others: Zoroastrian Trust Funds of Europe, Australian Zoroastrian Association of New South Wales, etc. If, for any reason, the FCRA registration renewal "does not come through, the poor of the community will endure great hardship," Tamboly observed in a WhatsApp message to Parsiana.

If the government cuts off foreign funding for NGOs for whatever reasons, the collateral damage will be borne by the most needy. Community trusts and organizations must voice their concern to the government on the dangers the stringent FCRA requirements pose to the Zoroastrians in India.