For the 10 departments that conduct surgeries at the Postgraduate Institute of Medical Education and Research (PGIMER) here, there are a mere 58 operation theatres. Not only do waiting times even for planned surgeries stretch to over a year, but, worse, lack of a management system means some OTs go unused despite high demand.
Of the 58 major operation theatres at the institute, usually 45 are elective OTs — where planned surgeries are performed — while the rest are for emergency operations. Numbers reveal more. Each of the 10 departments has around 15 surgical consultants, that is, senior faculty, while there are also senior resident doctors who perform surgeries. “There are 150-plus senior consultant surgeons, and hundreds of senior residents who are trained in specialised surgery. That means 400-plus surgeons, whereas there are not enough OT tables,” says a senior surgeon not willing to be named. “Now, if one sees the operative time, it comes out to be absolutely meagre.”
If the institute doubles “or even triples” the number of anaesthetists and also triples the number of OTs, the waiting lists can be managed and also better service can be ensured, says another senior surgeon from paediatrics.
‘IT GETS WORSE’
For paediatrics surgery, for instance, the wait is from three months to a year and a half; though there is no waiting time for life-threatening diseases.
In the urology department, there are seven consultants and 19 senior residents who get only 13 operation tables a week. “If we do minor cases, such as those needing one hour each, in a day we may be able to do up to eight cases. However, the PGIMER being a tertiary care centre, we are getting mainly complicated cancer cases. Sometimes, for instance, a bladder cancer operation can last 8-10 hours, which means one operation a day,” Dr AK Mandal, head of the urology department at PGIMER, said.
For urinary bladder cancer patients, the waiting time is three months. “We are doing 4-5 such operations in a week. In spite of that, at the moment we have got 28 such patients waiting in the OPD for operations. They have cancer of the urinary bladder and need to undergo radical cystectomy (removal of the bladder). They will wait anywhere between 10 and 12 weeks.”
Can they wait for such a long time? “This is a tragedy,” he says, “I have no hesitation to accept that their disease actually worsens. What can I do? If I give priority to them, the other critical patients will also have to wait. Beside bladder cancer, we have got kidney cancer, kidney stones with kidney failure, and other cases.”
He adds, “The problem is that, in Chandigarh, GMCH (Government Medical College and Hospital), Sector 32, and GMSH (Government Multi-Specialty Hospital), Sector 16, do not carry out these operations, nor do the ones in Mohali or Panchkula. Only in the private sector, sometimes such operations are performed. But, if PGIMER is doing 20 such operations, a private hospital would be doing one.”
For kidney stones, at the moment 130 patients are waiting and they will have to wait for more than three months. “What we need is at least 18-20 tables functioning per week,” he says.
‘ONE ROBOTIC OT NOT WORKING’
The institute has a robotic centre for surgeries too, but one of two such is lying nonfunctional since 2014, because of shortage of anaesthetists and anaesthetist technicians.
“In the robotic centre, we have got two state-of-the-art operation theatres. All the equipment is there, but we are able to run only one OT. Four to five senior consultants have retired from the anaesthesia department, and recruitment has not taken place,” says Dr Mandal.
“Right now, I have come from the anaesthesia department and have requested them to provide staff (two anaesthetists and two technicians) so that I can run the second OT.”
The department gets the OT 13 times a week, “and we do 50-55 surgeries per week”.
“If the other table is also made functional, we will be able to do 20 more operations per week,” Dr Mandal says.
The plastic surgery department gives priority to patients with congenital abnormalities or post-trauma deformities. For other cases, when patients are stable and there is no risk of death if the surgery is delayed, the minimum waiting period is four months. For example, cleft lip patients.
In general surgery, while priority is given to cancer patients and other complicated cases, there are some surgeries for which the waiting line keeps getting longer.
For example, for hernia repair, the waiting time is up to one year; for gall bladder removal, it is six months.
A new OT complex is in the works, and will house at least 35 operation theatres. Such is the state that the current 18-table OT section in the institute’s Nehru Building is more than 50 years old.
“We had been demanding a modern OT complex and have finally set the ball rolling. Now let’s see how long the institute will take in constructing it,” says PGIMER Faculty Association president Dr TD Yadav.
Also, he says, “There is no OT management system at the PGIMER. Several times, OTs remain unused. There should be system to ensure that infrastructure is properly utilised.”