Trauma centres: How public healthcare failed people
Ejaz Kaiser, Ruchir Kumar and Subhendu Maiti, Hindustan Times
Updated: Nov 30, 2014 15:19 IST
The 100-bed KD district hospital in Kanker, Chhattisgarh, is the lifeline for more than 7.5 lakh people, most of them poor tribals. More often than not, the lifeline fails them.
Last week, Dhaniram, 34, lost his 18-month-old daughter because she did not receive a life-saving blood transfusion in time.
"We found the blood bank locked. By the time the attendant arrived late in the evening and we found a donor to replace the transfused units, my baby was gone," says Dhaniram, a small farmer who had travelled 40 km to try and save his child.
Dr RC Thakur, civil surgeon at Kanker, says the hospital doesn't have dedicated staff for the blood bank. "We did all we could. The baby had critically low haemoglobin and at least an hour is needed to arrange and match blood groups before transfusing," he says.
Patients say there are more pigs and monkeys in the hospital than staff. To treat 350 to 400 patients a day, there are four specialists against the sanctioned 12, and 20 nurses against the approved 40. Add to that approved leave and unapproved absenteeism - doctors are routinely an hour or more late for their OPDs - and patient care becomes a casualty.
The challenges faced by this district hospital - infrastructure, equipment and staff shortages - are nearly identical to those in government-run hospitals in numerous other states.
NOT ENOUGH BEDS
India has less than 20,000 hospitals and 6.28 lakh beds for a population of 1.21 billion; only a third of these are in rural areas. Even state capitals face a dearth. Patna Medical College Hospital (PMCH) has 1,675 beds. Its 100-bed Emergency ward has an occupancy of 194%. This means that on almost all days, each Emergency bed is being shared - or, for almost every patient in a bed, there's another being treated on the floor.
In the neonatal ICU, there are only 19 beds for an average patient load of nearly 200 newborns a month. Two to three babies often share a cot. Against 1,285 sanctioned posts, there are 865 nurses, so relatives of patients are asked to double as nurses, collecting prescriptions and feeding medicines to patients themselves.
In a state where power supply is intermittent, operation and delivery rooms have no uninterrupted power backup, which means critical surgeries and procedures are interrupted for precious minutes until generators are turned on.
In Kolkata, Bhutnath Das, 64, is treated on the floor of the cardiology department at SSKM Medical College and Hospital, eastern India's premier state-run post-graduate medical research institute. His legs are tied to a bed near him and he's being fed intravenously from a saline bottle hanging from a window grille.
SSKM needs at least 2,200 beds to meet the current patient load, but has 1,700. Patients have to wait seven to 10 days to get reports of simple blood or urine tests, while the wait for mechanised tests such as an echo-cardiography to screen for heart problems is at least six months. The reason: shortage of laboratory technicians, Group D staff and high-end equipment.
POOR INFECTION CONTROL
Overcrowding and infrastructure shortfalls affect quality control the most. In Patna Medical College Hospital, for instance, carbolisation (a disinfection procedure) of cots and equipment is not done at all, not even in ICUs or operation theatres (OTs). Nor is microbial monitoring of asepsis (to prevent infection) done on the OTs, wards and mattresses, which is mandatory in all hospitals.
There is also no surveillance mechanism for hospital-acquired infection, with mandatory gowns, masks and shoe-covers not provided to visitors, who appear to have unrestricted access to OTs and ICUs.
Doctors at Dufferin Hospital, the biggest hospital for women in Kanpur, Uttar Pradesh, say that they don't trust the quality of medicines available either. "Often, we are accused of prescribing medicines from outside. Substandard quality is the reason," says a senior doctor, on condition of anonymity.
At east Delhi's Guru Tegh Bahadur (GTB) Hospital, one of the local government's biggest, with 1,000 beds and an average daily footfall of 4,000 patients, the Emergency OT has remained shut for two years, ever since it was destroyed by a fire. As a result, 20 to 22 surgeries are done in three makeshift OTs each day, raising the risk of infection.
"We are closely monitoring the construction work and expect it to be completed in a couple of months," says medical superintendant Dr B K Jain.
What's plaguing hospitals is not budget shortfalls, but poor planning. Mamata Banerjee's government is pumping crores into a cosmetic face lift for SSKM, with automatic doors and prettified seating areas, but little attention is being paid to improving medical services, adding beds, upgrading laboratories or acquiring lifesaving equipment. In Delhi's GTB Hospital, patients are asked to buy essentials such as surgical sutures, gauze, blood vials and pads for dressing because the hospital often runs out.
Delhi's GTB superintendent blames the long winded drug-procurement process for the shortfalls.
Clearly, healthcare management needs to get more efficient. Under the Centre's brand new National Health Assurance Mission, the Modi government has promised more than 50 free drugs, a dozen diagnostic tests and insurance cover to treat critical illnesses to India's 1.21-billion population. The first phase of the Rs 160,000-crore programme will roll out in April, but for it to work, healthcare delivery has to work on the ground.
IN MUMBAI: OVERCROWDED, UNDERSTAFFED
An old woman lying on a stretcher, wearing an oxygen mask, sobs in the middle of the entrance podium at KEM Hospital, Mumbai. "Don't cry or you'll have a bigger heart attack," says a young doctor attending to her.
A few feet away, a shrivelled, motionless woman is being carried to an examination room. The corridors are narrow and crowded with patients and their families; it takes three tries before the two ward boys are able to manoeuvre her stretcher through the doorway.
With a monthly footfall of over 50,000 and around 6,600 in-patients, King Edward Memorial (KEM) is the busiest hospital in Mumbai, catering to the sick from across the state and beyond. With just 1,800 beds, it treated about 6 lakh people in 20013-14, according to NGO Praja Foundation's data.
The hospital, which boasts among the best surgeons and doctors in India, is unclean, bathrooms filthy, and the wards dingy and overcrowded. People wait their turn lying on stretchers in the corridors outside Emergency, and it's not unusual to see in-patients allotted thin mattresses on the floor or under beds in the general wards.
Getting admitted can take hours, as can being discharged. "It took me two hours to get my friend registered and admitted. He has a bladder infection, but what if he had been critical?" says Tukaram Bhise*, a farmer from Maharashtra's Dhule district.
"Due to overcrowding at KEM, there is a considerable gap between the demands and expectations of the patients and the available infrastructure," says hospital dean Dr S Parkar. "Crowd management is also a problem. Dealing with a large number of patients and three to five times more relatives is challenging."
"It is a telling statement on the state of public healthcare in India that KEM is still one of the better government-run hospitals. It has incubators, for instance; an incinerator for medical waste; and rarely runs out of essential drugs. There is uninterrupted power and water supply. These things cannot be said of a large number of civic and government-run hospitals in the country," said Milind Mhaske, project coordinator at NGO Praja, which works to promote good governance in Mumbai.