A three-tier structure, infected from the bottom up
Every morning, there’s a long queue outside the civic health post near Mega Mall in Oshiwara. The people in that queue are not there to see a doctor; they are there to relieve themselves.mumbai Updated: Mar 09, 2010 01:23 IST
Every morning, there’s a long queue outside the civic health post near Mega Mall in Oshiwara. The people in that queue are not there to see a doctor; they are there to relieve themselves.
The one-storey health post, which is supposed to focus on preventive healthcare, has been lying vacant for more than three years because the BMC has not posted a doctor there — it wasn’t long before slumdwellers began to put it to its current use.
For the same reason, a civic maternity home near Milan subway at Santacruz has become a place for children to play hide-and-seek. Built by the BMC in 1990, this 2,000 sq ft hospital shut down soon after because of “inadequate staff”.
The 168 health posts and 163 dispensaries — the lowest rung of Mumbai’s three-tier civic healthcare system— are supposed to focus on preventing diseases and treating minor ailments.
Patients are ideally supposed to go to dispensaries first. Doctors are then expected to refer them to the nearest secondary hospital. They are to be sent to the city’s three super-specialty hospitals only for major illnesses or complicated surgery (see box).
But a significant number of the health posts and dispensaries are barely functioning. For instance, a doctor visits the dispensary at Ajgaonkar plot in Jogeshwari only on Saturdays, for no more than three hours. Ideally, he should be there at least five days a week.
As a result, the three teaching hospitals — KEM, Sion and Nair — are overburdened with patients with relatively minor complaints that ought to have been handled lower down in the system.
“The lowest level of the public health system and decentralisation have failed,” said social worker Leena Joshi, who works in the Govandi slums. “At least 60 per cent of patients should be dealt with at the primary and secondary level so tertiary hospitals can concentrate on serious, complicated cases.”
On Saturday morning, ward 23 at Lokmanya Tilak General Hospital, Sion, was teeming with women patients who needed surgery. Apart from the 32 women occupying cots, there were two rows of about 15 patients lying on mats on the floor. During the monsoon , when water-borne diseases are common, sometimes two patients share a cot, or there’s one on the cot and one on a mat below, far exceeding the 1,422-bed hospital’s capacity.
Barely seven kilometres away, at Parel’s KEM Hospital, hundreds of people stood in queues to see the doctors. Some had traveled more than 400 km from Jalgaon, Beed and Latur districts for a range of ailments.
At least 5,800 patients are treated at the 1,800-bed hospital’s Out Patient Department every day. Overworked and weary doctors barely spend a few minutes examining each patient.
Officials plan upgrade
“There is a failure of the referral chain,” Dr Sanjay Oak, director at BMC’s teaching hospitals, admitted. “We have the infrastructure, but we need better technology and committed manpower to make the primary and secondary health facilities work.”
The BMC has plans to upgrade many secondary-level hospitals in the suburbs but they are on hold due to “lack of funds”. Dr Oak said the BMC is also in the process of setting up maternity hospitals at Andheri and Magothane in Borivli.
Once that happens, women like Sweety Shinde (26) will not have to make the two-hour journey from Nallasopara to KEM Hospital. The homemaker, who is six months pregnant, went to KEM last week to register for her delivery.
“I am worried about travelling once labour pain starts but I have no choice. There is no public hospital in Nallasopara (East), and the one in a neighbouring area does not have good facilities,” she said.