Bicholia .. .. ..

Most of you would not know what this means . . .

Bicholia . . . This is the local terminology which is used in this part of the country for middlemen. 

We see quite a lot of them everyday. Of course, one could argue that you find them in various forms in different parts of the country. We call them by various names . . . lobbyist in the government, middlemen in business etc. 

However, bicholias here are of a different type. 

The major thing being they exploit the poor. 

We have a very sick eclampsia patient in Acute Care. It's been couple of days since she was brought in. And she was well into a HELLP Syndrome when we admitted here. We thought about delivering her by Cesarian section if we got at least 3 pints of blood. 

The family being poor . . . that was a huge ask. However, someone helped them to arrange one pint of blood. But that came after 24 hours of admission. 

We have already induced her twice, but without any result. Today evening, I've started to induce labour for the third time. 

However, as I reached the Acute Care before I left hospital, there was this well off person who was showing off . . . talking loud . . . and making a scene of what we were doing with PrD. I explained that we've already told the family to take her to a higher centre. Then, he took out the slip which we wrote for obtaining blood couple of days back and asked me whether he could do something to bring the three pints. 

I told him it is too late now as the condition of the patient has worsened. 

I asked him who he was. The usual answer of a bicholi . . .'I happened to find this poor family trying to find some help. So, I thought about helping them out.' 

The rates can be as low as 100 INR to as high as 10% of expenses involved. We find the latter when the 'bicholia' gets involved in getting a charity written from the hospital. 

We've enough reasons to suspect that many of the 'bicholias' get involved in some form of bonded labourer especially when the poor cannot pay the 'service rates'.

By the way, it is not alone in hospitals such as ours that we find these middlemen. I understand that there are major players who work in the banks and other government offices. 

As part of the community development work we do, we're involved with Self Help Groups. Recently, when we wanted to facilitate obtaining bank loans, we found out that it can only be done through 'bicholis'. The rates they were asking were humongous.

For a loan of 200,000 INR, one has to pay as high as 40,000 to 60,000 INR. 

And it is so rampant . . . 

Of course, I feel that this is one of the major reasons that many of the well meant government schemes do not reach the real. 

There are no easy answers on how to tackle this menace . . . but I hope that this will be open the eyes of people in 'INDIA' about the travails of the populace of 'BHARAT'.   

Moneylenders . . .

The rural Indian hinterland is not complete without the active presence of moneylenders. They usually belong to the business class. They are know by different names in different regions of the country.

Today I was reminded of the chaos that a moneylender can bring about in the life of a commoner. I was sitting in the cool air-conditioned environs of my office, when a shabby looking young lad of about 19 years walked in. It was obvious. He wanted a concession for the treatment of his wife. 

GD, his wife had come about a week back after having been in labour for more than a day. And she was terribly anemic. We operated after the relatives arranged one unit of blood. Per-operatively we found out that the uterus was already ruptured. The baby was lucky to have made it alive, although a bit sick. 

The total bill for both mother and baby came out to about 17,000 INR. He had brought 10,000 INR. The baby's bill was about 2000 INR for which we gave full charity from Grace Babies. That left 5000 INR. I haggled with him to at least pay 2000 INR more. He fell to my feet and told me that he has brought all that he could afford. 

I asked him how he managed 10,000 INR. It seems he had taken it from the local moneylender.

To all of you who know the moneylenders in the rural areas of India, this may not be new. 

I asked him about the interest he would have to pay back. The calculations are astronomical and unethical. Let me put it in simple terms. 

The interest he is being charged in 10% per month. And he is paid 10% less of what is taken. 

Which means, if I borrow 100 INR, I would get 90 INR. If I pay within one month, I would have to pay 110 INR. If I pay the next month, that would be 121 INR. So you can calculate how much I would have to pay if I take one year to pay the money off. 

If my mathematics is correct, if I pay a 100 INR loan after 1 year, I would end up paying 314 INR. Imagine, getting a loan for 90 INR and paying back 314 INR. Recently, someone told me that there are some fairer moneylenders who take 10 INR per month for 100 INR. So, if you calculate that way, that would still be 220 INR after one year.

Imagine, GD's husband getting 9000 INR. He would be having to pay anything between 22,000 to 31,000 INR if he manages to pay back within one year. And there is the spectre of bonded labour which continues without much notice in most of our villages . . .

Poor families in rural India take such loans for three major reasons - agriculture (for purchasing seeds and fertilizer), unexpected ill-health and marriage ceremonies. Unless the monsoon rains fail, he is able to repay for agriculture costs. The problem is with the next two. 

My prayer would be that public health facilities would improve so much so that patients like GD would get the best possible treatment such that they would not need to approach facilities such as ours. Until that happens, I pray that we would be able to write off bills for patients like GD. . .


However, the Rashtriya Swasthya Bima Yojana is the best option available before us to bypass the moneylenders at least when the issue of unexpected healthcare costs arises. Unfortunately GD's family did not have an RSBY card.


We are proud to say that till today morning, we've had 868 RSBY beneficiaries accessing outpatient facilities (free registration and consultation) and 141 accessing in-patient care. The total costs should be around 700,000 INR of which we have got about 380,000. I'm glad that we could be of service to these many RSBY card holders in a short duration of not more than 4 months.