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Primary hell centres

india Updated: Apr 28, 2008 05:06 IST
Alifiya Khan

Barely 62 km northeast of Mumbai at a primary health centre in Thane district’s Padgha, medical officer Dr Ishwar Thite is a busy man. Apart from handling nearly 80 patients and conducting four deliveries on an average day, the ayurvedic doctor handles the occasional autopsy.

“Since the health centre is on the highway, accident cases regularly come in. I’m the only doctor to conduct the autopsy here,” he said. Questioned on his expertise in forensic science to conduct a post-mortem, he quickly replied: “We had studied it for three months in our college.”

Dr Thite, though, doesn’t remember conducting even a single autopsy in his college. His medical qualification — Bachelor of Ayurvedic Medicine and Surgery (BAMS) — entitles him to prescribe allopathic medicine only when no ayurvedic remedy is available for a particular condition. For him to conduct autopsies is not permissible.

The health centre in Padgha is not an exception. Across the state’s primary health centres, often the only modern, medical lifelines for hundreds of villages, ayurvedic doctors conduct post-mortem.

Over the weekend, Hindustan Times visited 12 primary health centres in Thane district — places in the penumbra of the Mumbai’s glitzy, multi-crore rupee healthcare system — and found qualified state appointed doctors were reusing disposable needles, exposing people to the risk of HIV and hepatitis B.

Basic emergency medicines for cardiac arrest or hypertension were missing, and so were ambulances and their drivers. Ignoring deep burial techniques, many staffers are dumping bio-medical waste in trash, a practice that the state authorities agree has been brought to their notice, but contend that the pollution board should take action.

The state health authorities did not seem to know about the autopsies at all. “Ayurvedic doctors cannot perform a post-mortem, and it doesn’t happen,” said P.P. Doke, director general of health services.

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Then, on Hindustan Times’ insistence, Doke checked with district medical officials and admitted that such a thing was indeed happening.

“We had allowed ayurvedic doctors to conduct post-mortems 25 years ago, when they had an integrated course. But about 99 per cent of these doctors have retired and the present batch isn’t supposed to do autopsies. I’ve just learnt about it and will now look into it,” he said.

Forensic science experts sounded shocked. “Only MBBS graduates can conduct post-mortem. How can ayurvedic doctors even claim to do it?” said police surgeon Dr S.M. Patil.

Some ayurvedic doctors came up with explanations. “I know we aren’t supposed to do autopsies alone, so I either call an MBBS doctor from the nearest hospital or send the bodies to the hospital,” said Dr A.R. More from the health centre in Shenva which covers some tribal villages around 85 km from Mumbai.

Other doctors seemed unaware about the illegality. “We are allowed to do accident cases. But for more complicated cases like burns or murder, we take the help of a MBBS doctor,” said medical officer R.N. Rathod from Khardi, 95 km out on the Mumbai-Nashik highway.

In these health centres, while the doctors risk the health of patients, the state seem to be putting the doctors at peril. Surgical gloves are missing, so are basic medical instruments like forceps and needle holders needed to suture wounds.

“There is always a shortage of gloves. We use them only for emergencies. There is an acute water shortage so sanitation is an issue. There is a perennial shortage of needles, suture material, anti-fungal creams and basic drugs, but we have learnt to manage,” said Dr Mohan Waghmare, medical officer at the primary health centre in Kasara, a one-and-a-half-hour train ride and a short rickshaw ride away from Mumbai.