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

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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

AIIMS OPD

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

India's healthcare conundrum

Anbumani Ramdoss, India’s Health Minister recently had occasion to highlight the vast gap in the medical workforce in the country. According to him, while the country had around 700,000 doctors, it needed 800,000 more to meet the standards of the World Health Organisation. He added that the country needed 1.5 million more nurses to achieve, as the Indian Planning Commission has indicated, the nurse-patient ratio of 1:500.

In order to overcome the huge deficit, conditions for establishing medical colleges have been relaxed. Sensing an opportunity for making a killing, poliiticians, their financiers and other influential and powerful business interests have got into the act. Colleges have been and are being opened any and everywhere regardless of the availalability or otherwise of the necessary faculty, equipment, patients and/or hospital-beds. Faculty members of distant institution are hired for few days to meet the needs of inspections, which, too, are rigged. Even fake patients are sometimes made to occupy, on payment, beds lying vacant in the attached hospitals.

A member of the Medical Council of India recently lamented the absence of accredition of medical education in India, the efforts being concentrated more towards securing recognition. The main reason for this aberration, he said, was the “absence of sincerity and moral values in the society”. While the Delhi High Court recently ordered closer scrutiny of Indian medical students graduating from abroad, it is almost time for such a scrutiny even of those who graduate from the mushrooming medical colleges in the country. Being products of an ongoing con-game, they mostly emerge as quacks armed with medical degrees. Instead of providing health care they are more likely to effectively deal with the acute population problem of the country!

Training and education of nurses is no different. Because of shortage of a million nurses, to achieve the ratio of a nurse for every 500 patients colleges have been allowed to be opened with scant facilities of teaching and learning. Producing nurses possessing, at best, rudimentary theoretical awareness with little knowledge or training in clinical applications, such institutions are only fattening their promoters doing nothing for the country or for the noble profession. Only the institutions of excellence that the government proposes to open may redeem to a limited extent the ongoing compromise in the quality of nursing.

The proliferating diagnostic labs are also an area of huge concern. According to the Quality Council of India, although 70% of the modern medical care is based on diagnostic lab tests, 90% of medical laboratories have remained unregulated by any standard. Most of the pathological laboratories do not follow any quality benchmark for want of stringent requirements. Here again, accredition (by government or other recognised agencies) is virtually absent and, hence, quality control is non-existent. Leave alone hygiene or sanitation, even sensitivity towards the need for a sterile ambience is absent. Qualified pathologists or radiologists are frequently unavailable. Inspections are unheard of and the entire system is governed by the hardly relevant Shops and Establishments Act. If this is what happens in urban areas one shudders to imagine the plight of the people in the country’s rural recesses. It is nothing but mockery of healthcare.

Instead of tackling these vital issues, Ramdoss got into avoidable controversies. His personal feud with the former Director of the prestigious institution of All India Institute of Medical Sciences, a cardiac surgeon of great repute, ended up with egg on his face and that of his government. Besides, to benefit a party apparatchik he banned production of vaccines by public sector labs, causing their widespread shortage that continues till date.

He, however, successfully imposed a ban on smoking in public places. He is now poised to move into the areas of drugs and alcoholism. Ramdoss’s strategy of mounting attacks on the lifestyle or habits or substances the pursuit and/or use of which cause deadly diseases necessitating heavy public investments for their treatment cannot but be appreciated. He however seems to be oblivious of the problem of food adulteration and use of toxic chemicals to ripen fruits and vegetables and to impart to them farm-fresh appearance. Health problems caused by water and air pollution are also nowhere on his horizon as yet.

India’s healthcare is a conundrum that would need much more than mere tinkering. To take care of health of a billion people, mostly poor, the immediate need would seem to be ruthless governance and rooting out of the prevailing rampant corruption in the health sector. And, the country is now at such a stage when penalisation of the states, the main instruments of healthcare delivery, for non-performance by blocking off their funding seems to have become necessary.