Odisha Tragedy: Why Are So Many People Forced To Take the 'Hospital Express'?

The Coromandel Express ferried hundreds of patients from West Bengal to Tamil Nadu seeking medical treatment.

(Photo: Aroop Mishra/The Quint)

Iva Banerjee, who hails from Kolkata, has taken the Coromandel Express multiple times over the past 10 years. The last stop of the train, Chennai Central, has been her destination each time.

Her husband, Subroto, who suffers from Age-Related Macular Degeneration (AMD), has been undergoing treatment at Chennai's Sankara Nethralaya and needs regular supervision from doctors.

Every day, hundreds of people like the Banerjees board the Coromandel Express – dubbed the 'Hospital Express' – from various parts of West Bengal and Odisha to seek quality medical treatment at some of south India's most reputed hospitals.

On the fateful evening of Friday, 2 June, when the train derailed and crashed with two other trains in Odisha's Balasore, claiming at least 275 lives, many passengers onboard were believed to be going to Chennai and Vellore for medical treatments.

Like Purulia residents Chandana Ghosh and her husband Subrata, who were taking their seven-year-old son Sayan to CMC Vellore that evening.

They had wanted to get him treated for a behavioural disorder.

However, on Sunday, Sayan suffered from multiple spine fractures and also sustained injuries to his feet and knees, reported The Times of India. The mother-son duo, who had got stuck beneath seats, narrowly escaped death that day.

But why is it that people from West Bengal feel the need to travel nearly 2,000 km for something that should be accessible to them in their own home state?

Why Do People Take the 'Hospital Express'?

Dr Anant Bhan, a public health expert who works in the field of global health and public health ethics, says that there are multiple reasons that people from West Bengal look to other states for medical help. These include:

• Lack of access to quality public healthcare

• Lack of trust in the system

• Positive anecdotal stories from people who have been treated at hospitals outside the state

• Presence of support systems near these hospitals that people from a particular region frequent – for instance accommodations, restaurants, etc are readily available for Bengalis near CMC Vellore and many hospitals in Chennai, where people from Bengal only are working and speaking the language

• More medical colleges in southern states

Dr Bhan explains:

"People rely on word of mouth when deciding who to consult for healthcare. Private healthcare is concentrated in cities like Kolkata and is expensive. So if you're someone living in a remote corner of Bengal, you'd prefer to go to a CMC Vellore that is a missionary hospital where the fee might be waived off."

The West Bengal government itself, under the Swasthya Sathi scheme, provides concessions to patients in all state government hospitals, AIIMS Delhi, and CMC Vellore. 

In 2021 alone, 4,000 people from the state availed themselves of the benefits of this scheme in CMC Vellore. 

What Patients Say About WB Hospitals

Abhijit Pal, who hails from Kolkata, took his father to Vellore's Christian Medical College for lung cancer treatment a few months ago. While he agrees that top hospitals in Bengal do provide cancer treatments, he alleges that the "process is not smooth" with huge "delays in appointments and procedures."

Before Pal took his father to Vellore, the latter was admitted to the Kolkata Medical College and Hospital. Pal, alleging incompetency in the hospital, says:

• The OPDs functioned only for 2-3 days.

• There were no experienced doctors who could communicate with the patients' families.

• The hospital was short-staffed with one nurse and doctor managing over 20 patients, and they were unable to provide quality care to each patient.

"For my father's biopsy, CMC Vellore took only one day, and the same procedure at Kolkata Medical College took six days."

Abhijit Pal

Banerjee also agrees with Pal. She tells FIT, "The arrangement and treatment quality in Chennai are much better than Kolkata. We go there for other medical concerns as well."

Are the healthcare facilities in the south cheaper or more affordable? Not exactly, but there's a sense of trust in the institutions there that seems to be lacking in Bengal.

However, the trust that the patients and experts speak of is not on the institutions themselves, but only on the doctors.

Banerjee says, "Now Sankara Nethralaya has a branch near Kolkata as well, but for special treatment, we go to Chennai only."

Dr Bhan understands where this trust comes from. He says:

"There is a comfort level and a sense that a legacy hospital would have more expertise and more experience. That's essentially the difference between an AIIMS Delhi and an AIIMS Patna. The quality might be the same, but if you manage to get an appointment, you'd prefer the former."

Inequitable Distribution of Quality Healthcare

All of this points to the broader issue of inequitable access to good quality healthcare, Dr Bhan tells FIT. He says that the policy response needs to be towards filling this gap so that "the burden on some key institutions can also be eased."

Dr Pooja Tripathi, a public health specialist, agrees with Dr Bhan. She says that the gap needs to be filled in terms of manpower and infrastructure across secondary and tertiary healthcare setups in West Bengal.

She adds that proper monitoring systems, redressal systems, and incentivising doctors to work in remote areas could work wonders.

Dr Sonali Vaid, also a public health expert, adds that this problem is not unique to West Bengal alone. Except for basic treatments, people from all over the country travel miles and miles for medical help.

However, both Dr Vaid and Dr Tripathi are also concerned about what the Centre's future plans for healthcare might unfold in places like West Bengal where there's already a huge disparity.

Dr Vaid tells FIT:

"There is a disparity among different states and within states too. This is going to become more of a problem because of the Government of India's district hospital PPP plan. They're going to lease government district hospitals to the private sector."

She goes on to add, "This will lead to more and more people going directly to government medical colleges, which will of course be much further travel-wise and which might also get overwhelmed with the increasing patient load. Either that, or people will have catastrophic medical expenses at private facilities and become poorer. Or they will neglect their health issues."

Dr Tripathi has the same worry. For her, the basic funda is that healthcare needs to be free across all sectors. Not only should your treatment be free or subsided, but a patient shouldn't have to go worrying about how much tests for private labs might cost.

She says, "We need to have a robust public healthcare system, until then people will keep travelling for affordable treatments."