Living India: Doctor couple who built a cheap hospital
At first sight, the cheerful-looking red and white painted building looks like a quiet public rest house in the din and bustle of Hajipur, a fast developing town in India's northern state of Bihar.
But look closely and you see a stream of people entering Aastha Hospital, run by an enterprising doctor couple who left lucrative jobs in India's private sector to set up a facility offering quality treatment at affordable prices.
In the process, surgeon Atul Varma, and ophthalmologist Jayashree Shekhar, have upended the widely held notion that you cannot get quality healthcare in India unless you are affluent.
After all, India spends a paltry 1% of its gross domestic product (GDP) on health, which is among the lowest in the world. At 69% of total household expenses, private spending on health is among the highest in the world. Millions of Indians become bankrupt meeting medical expenses. Although the state provides free treatment, only 22% of people in villages, and 19% of people in cities access government-run outpatient facilities.
Things are worse in Bihar.
The public health system is in a shambles although the state has some 800 government hospitals and primary health centres, and about 2,000 private nursing homes or clinics. Federal laws regulating private facilities are routinely flouted.
Just one doctor for every 18,000 patients makes for overworked physicians and suspicious patients. Reimbursement for a modest state-funded health insurance for the very poor is difficult to raise without paying a bribe. By one estimate, two-thirds of medicines in the wholesale market are spurious.
Seven years ago, the doctor couple returned to their native state after working at home and abroad. Dr Varma worked in a state-run hospital, before they decided to set up their hospital.
"At one of India's largest public hospitals in Delhi, where I worked for a while, I found patients from Bihar helplessly waiting for admission for days on end. Their relatives would come with folded hands," says Dr Varma, 43.
"There was little we could do, as there were no beds available. It got me thinking that we needed to do something back home."
They took out a bank loan to buy an ageing school building - the school moved to a new place a few blocks away - and revamped it into a 3,600 sq-ft (334 sq-m), 12-bed hospital which opened last year.
Every detail has been attended to: A spacious consultation room, a clean and functional operation theatre, fireproof wiring, a medicine store, water mats to keep the place cool in Bihar's bristling summers, and airy ventilation.
'All is not lost'
The ground floor waiting hall sees patients every day and Dr Verma carries out minimally invasive keyhole, vascular and general surgeries on patients who often come from far-flung villages.
The clinic charges 200 rupees ($3.18; £2.12) for consultation, and between 8,000-12,000 rupees ($127-$191; £84-126) for surgeries. This is a fraction of what some 500 other nursing homes in Hajipur charge their patients.
Two trained counsellors talk to the patients and "educate" them on their ailments.
In its short and thriving life, Aashtha Hospital has treated patients as varied as a two-hour-old baby born without a rectum, to a 108-year-old man who was wheeled in for prostrate surgery.
The couple both run crowded clinics in the same neighbourhood, offering cheap treatment to hundreds of patients every day.
There is no reliable supply of water or electricity - power cuts are common, and a diesel generator provides a backup. They take more than 90 minutes to cover a single 18km- (11-mile)-long journey from their home in Patna city by a bridge infamous for its nightmarish traffic jams.
"Sometimes," says Dr Varma, "I am so fatigued when I reach the hospital that I am not fit enough to see the patients."
But the couple has no plans to give up.
They plan to expand the hospital and add a floor so that Jayashree can see her patients there. In a bigger, more audacious plan, they have sought 40,000 sq-ft (3716 sq-m) of wasteland at a subsidised price from the government to build a 100-bed hospital for the poor.
That was more than three years ago. They are still waiting.
"There is no giving up," says Dr Varma. "All is not lost."
The story of Bihar's doctor couple features in the three-part series The Documentary: Living India, presented by Rupa Jha and beginning on the BBC World Service on Tuesday 10 March at 22:00-22:30 IST.