Wednesday, September 28, 2016

Bhopal Notes:: 40 :: Inadequacy of healthcare in Bhopal

Hamidia Hospital Registration area - a much thinner crowd than what we came across
Being retiree of the Central Government I am a beneficiary of the local dispensary of Central Government Health Scheme (CGHS). This somewhat detaches me and others like me from the system of state government healthcare. I said “somewhat” as we too are not entirely free to seek healthcare from any quarter. The check is applied when new medicines or investigations are prescribed or hospitalization is suggested. At that point of time, unless there is an emergency, we have to go to a local State or Central government hospital for the necessary recommendations by a specialist. Bhopal CGHS has six doctors but none of them is a specialist. 

Such an occasion arose recently and my wife and I went to the Hamidia Hospital to visit the Orthopaedic out patients department (OPD). We were horrified to see the crowds at the registration area. There must have been around 500-700 people waiting for registration. Huge queues stretched from the general, women’s and senior citizens’ counters. Since both of us could not have stood all that while for registration because of our age and skeletal problems we decided to call it a day deciding to try our luck at the All India Institute of Medical Sciences (AIIMS), a central government institution.

 We had been there once earlier about two years ago and were able to visit the OPD of an orthopaedic surgeon even though we reached the distant place around 10.00 AM. We reached this time too around the same time only to be told that registration had been closed at 9.00 in the morning after commencing at 8.00AM. The man at the counter told us that only 40 out-patients are registered because of limited availability of doctors and people wait outside from 3.00AM onwards. The counter officer suggested to us to try online registration. My wife tried that too to find to find to her shock that no orthopaedician was available till March 2017.

 Compelled as we were, we visited the private clinic of a senior orthopaedic surgeon of the Hamidia Hospital whose recommendations were promptly acted upon by the CGHS. The only difference was that we had to pay the government orthopaedician a tidy consulting fee for his labours in his private clinic. The CGHS does not act upon prescriptions of specialists from its own empanelled private hospitals in identical circumstances but, surprisingly, the medicinal and diagnostic recommendations of a government doctor made from his private clinic are somehow considered sanitised enough for it to act upon.

Such are the rules, call it hypocrisy or what you will. Another anomaly is that while one can avail of the treatment of an empanelled private hospital as an in-patient but one cannot do so as an out-patient. A specialist there is good enough to deal with any number of serious and life-threatening diseases involving costly investigations or surgical procedures but their recommendations/prescriptions handed out from their OPDs are not acceptable. That probably is because of governmental distrust of private hospitals because of their frequently reported unfair, greedy and exploitative practices. But, I am digressing.

My point was different. What I was aiming at was the utter inadequacy of the governmental healthcare system in Bhopal. The crowds for registration at two hospitals are indicative of that. One would be surprised if things happen to be different in other urban centres of the state. For that matter even the Red Cross Hospital which earlier used to appear better provided these days wears a look of inadequacy. There too a large number of patients were seen waiting for attention of a medicine man. Either that or there is total breakdown of public health that produces huge number of patients crowding around government hospitals where treatment is much cheaper. Those who can afford can go to corporate hospitals to get treated and/or looted but the poorer sections do not have that alternative or option.

 This is what is happening in an urban area – the capital of the state; what happens in the rural and remote areas is any body’s guess. Only sparsely distributed health centres, with inadequate number of physicians/surgeons and para-medics, attend to the needs of hundreds of thousands as out or in patients. Over-population, illiteracy and lack of awareness about sanitation and hygiene give rise to heavy incidences of communicable and non-communicable diseases. Deaths are frequent; not being rare, unlike elsewhere life is cheap here  No wonder, the likes of Dana Majhi have to admit his wife in a hospital 10 kms away and then walk back home lugging her on his shoulders after she unfortunately dies.

Two governments, one each of the Indian National Congress and Bharatiya Janata Party, have had uninterrupted runs of 10 years each in the state, yet apparently they did not do a thing to improve the healthcare system of the state either in the rural areas or in its urban centres. Bhopal, for example, has a handful of government hospitals for a population of more than 20 lakh (2 billion).  At best there are only half a dozen government hospitals if you leave out the ones like those of Bharat Heavy Electricals Ltd., Railways, Army, and the ones meant for victims of Gas Tragedy of 1984 etc. The city has expanded practically on all sides and all this must have taken place with the approval of the relevant government agencies. But there is hardly any government hospital that was planned for or built in these extended areas. One wonders what the Town and Country Planning organization and the department of urban development/administration or, for that matter, the department of health were doing. Apparently, the state progressively withdrew itself from its obligation of providing healthcare to a burgeoning population at reasonable costs and left avery large section of the population at the mercy of the rapacious corporate and other private hospitals. They hardly can afford the jacked up costs of such hospitals’ consultants’ fees or of medicines from their in-house pharmacists, or, for that matter, the numerous investigations that they mostly have conducted for raising their own revenues.

It is only now that the state elections are approaching that the state government is talking of augmenting the healthcare facilities. They have said that the Hamidia Hospital is going to have as many as 2000 beds. One wonders whether its rusty and creaky administrative organization would be able to manage such a huge establishment when it cannot manage the same hospital with 500-odd beds where replacing a broken-down old lift takes more than a year. It also does not have either a MRI machine or a CT scan machine. The machines that were reportedly procured for conducting angiography have hardly been put to use.

The government is also asking the Centre to transfer the Bhopal
Memorial Hospital & Research Centre (BMHRC) to the state. It was a very well built hospital with well-qualified physicians and surgeons with the funds provided from the (measly) compensations paid by the Union Carbide Ltd. After the Trust that ran it was wound up it was tossed from one agency of the department/agency of the Health Ministry at the Centre to another that broke its back bone and landed it in an unholy mess. The mess that was created
was a fertile ground for the local corporate hospitals to poach its qualified and experienced specialists on payment of astronomical salaries. The mess continues and in this mess the state government wants to wade in mainly because of the hospitals excellent property. If ever the state government happens to control it the mess will be bigger and it may run as a close second to the messy Hamidia Hospital

Surprisingly, the government is aiming at big establishments when the needs are of smaller units located in various newly established localities. These could be like general hospitals providing the rudimentary first level of medicinal or surgical treatment. Every sick person need not visit a multi-speciality hospital as a large number do not need the attentions of specialists. Perhaps this way the patients would be treated in a better manner and the physicians/surgeons would be able to pay greater attention taking their time in examining and suggesting treatment to them The dreadful amount of waiting that common sick and suffering people have to undergo under present conditions need to be immediately addressed. Whether the government is able to do it will have to be seen. We may have to have a long  wait for its reaction too.

*Photos: from internet

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