Verghese was rare because his American (and fast-track Indian) peers were chasing the big-buck super-specialities, unprepared for a new infectious disease that caught America, literally, with its pants down. Sure, his lowly speciality became Verghese's ticket to more than fifteen minutes of fame, even if it consumed his first marriage, but his colleagues back home aren't as lucky. You'd expect public health specialists -- thepeople who dabble in infectious diseases -- to be on top of our medical hierarchy, but that is not so, for our medical priorities are still urban, elite-driven. Worse off is the rarer species that opts to work in the villages. In a nation where a Naresh Trehan is a regular society column fixture, the rural doctor is the archetypal unsung hero, unless, of course, a Magsaysay Award leads to the discovery of a Raj Arole, or The Lancet reports Abhay and Rani Bang's work in Maharashtra's Gadchiroli district. There's not even an A. J. Cronin to chronicle their fascinating lives.

Isn't it a shame there's an Indian doctor serving every 1,325 Americans, while in India the ratio is one doctor per 2,400 Indians? We've grown up hearing generations of our political elite telling us that 80 (it's now 70) per cent of our population lives in rural India. But if they had their heart where their motor-mouths were, we wouldn't have had a situation where there are 152 hospital beds per million rural Indians, which ismore than 15 times lower than the urban equivalent (2,409 beds per million). And remember, national averages can never tell the entire Indian story -- in Uttar Pradesh, for instance, it's a 23-1,619 divide: 23 beds for a million people in a state where politicians have made a living milking the rural electoral cow!

So, we have a situation where 70 per cent of our 17,000 new medical graduates every year opt to work in big cities and small towns, that too overwhelmingly in the private sector. It is because our elite, even that part of it with rural roots, is citified to the extent of being insensitive to rural reality. We keep seeing this attitude being expressed in many of the actions taken by those in power. If their decisions don't make sense most of the time, the wave of health-care legislation that is sweeping the states would make even the mildest of us balk.

The purpose of these new laws -- already in place in Bihar, Madhya Pradesh and Tamil Nadu, and being considered in Andhra Pradesh, Gujarat,Karnataka, Kerala, Rajasthan and West Bengal -- is to regulate the mushrooming private sector, which is all very good. But the laws are riddled with deficiencies that may only exacerbate the urban-rural divide. The laws have been made with urban nursing homes in mind, but are applicable even to the few rural hospitals set up by doctors with a conscience, who have shown it is possible to make a decent living even in those areas that their urban peers avoid like the plague. So, these laws impose limitations that, if made applicable to the public sector, which, as usual, enjoys complete immunity, would lead to the closure of all government-run health institutions.

Take, for instance, the requirement that all nursing homes and hospitals must have trained nurses and anaesthetists. It sounds very good, but in a country where there's one nurse to a doctor, when World Health Organisation norms prescribe tree, and where nurses, unless charitably inclined, have no reason to go to villages, most rural hospitals haveward boys and female attendants doubling as nurses. It's better to have them, than have no nurses at all. Anaesthetists, similarly, don't grow on trees, and they make too much money in the cities to be drawn to villages, so, again, rural hospitals more often than not have MBBS doctors doubling as anaesthetists. So, the new laws, despite their good intentions, will have to make a distinction between the rural hospital and the urban nursing home, between the voluntary sector and the profit-making private sector.

The reason why the laws have to make these distinctions is that rural hospitals are up against odds imposed by constraints due to the economic conditions of the places where they are located and of the patients they serve. It makes no sense, for instance, to insist that R. R. Tongaonkar's hospital at Dondaicha village in Maharashtra's Dhule district be governed by the same blood transfusion rules as are applicable to Medinova, Hyderabad. To expect a licenced blood bank with air-conditioning and theworks even within a motorable distance from Dondaicha, is like expecting water on the moon. Does that mean a child injured in a thresher accident should be left to bleed away, while blood is organised for him from the nearest certified blood bank several hours away? Today, Tongaonkar manages with drawing blood from the relatives of patients he operates on, for the blood bank nearest to him is a four-hour tractor ride away. Tomorrow, if the new laws are written into the statute books, will accident victims at Dondaichi have to bleed to death? Time for a reality check, don't you think?