Farheen Ahmad (56) and her daughter Ramsha (37) left their home in northeast Delhi’s Seelampur at 6 am, armed with packed lunches, a water bottle and a blanket. It was, after all, going to be a long day.
They reached Lok Nayak Jai Prakash (LNJP) hospital a few hours later and queued up for an MRI test which, doctors had said, was needed to assess Farheen’s heart. “My mother has been having heart problems. I don’t want her to wait too long, so it’s better to reach early. But you never know,” said Ramsha.
Delhi has 34 hospitals run by the state government, with over 11,000 beds and a daily influx of 50,000 patients, 40% of whom come from outside the capital, said officials. Of these, LNJP, established in 1936, has 1,847 beds and remains the only Delhi government hospital with a functional MRI machine. Doctors estimate that more than 10,000 people avail its services annually. The hospital had acquired the machine in 2015 for Rs 15.35 crore.
According to doctors, an MRI scan — short for magnetic resonance imaging — is required to detect cysts, injuries and abnormalities across the body. The absence of an MRI machine is, perhaps, the most glaring example in a long list of equipment lacking in government hospitals, with The Indian Express discovering that a similar problem exists when it comes anaesthesia workstations and, occasionally, providing oxygen.
Just last month, Chief Minister Arvind Kejriwal had pulled up the health department for the delay in procuring equipment, with the CMO saying it will take up the issue with L-G Anil Baijal, if required.
An uphill task
In February 2016, the AAP government in Delhi had announced that diagnostic tests, usually priced between Rs 1,500-3,000, would become free for patients. Tenders for five MRI machines were floated the same year, but nothing has been procured so far.
Reasons for procurement delays vary. According to a letter written on April 4 to Health Minister Satyendar Jain and the CM by health secretary Raajiv Yaduvanshi, “some delay had occurred in purchase of equipment because, earlier, the procurement process was initiated at the level of the medical superintendent. But subsequently, it was decided to be done at the central procurement agency (CPA) level.”
The adjacent GB Pant Hospital, commissioned in 1964 and currently offering treatment to 3 lakh patients annually, was the first Delhi hospital with an MRI machine. Over the years, new beds and wings have been added, and a sign in one of the corridors even points to the ‘MRI room’. But it remains locked, and currently acts only as a storage space for fire extinguishers, with a solitary guard outside. The MRI machine has not been functional since late 2015, and a new one is yet to be procured.
The University College Medical Sciences, attached to GB Pant Hospital, also runs a three-year course in MD Radiology. But without an MRI machine for students to learn on, radiology aspirants are sent to Safdarjung Hospital for a month. “It’s an absurd situation, like studying geometry without a scale. Imagine having to travel an hour, every day, just so that you can borrow a scale,” said Vidushi Srinivasan, a student.
A doctor at GB Pant, who did not wish to be named, said, “The MRI machine didn’t stop working; it was condemned because it reached the end of its life. We have been asking for a new one for nearly three years, with numerous reminders.” The hospital, incidentally, takes the lead in conducting neuro, cardio and gastrointestinal surgeries — all of which mandate MRI scans. Outside, an MRI scan can cost between Rs 1,500-14,000, said doctors.
The AAP government has made a series of efforts to reduce the load on government hospitals. In January this year, the L-G had approved the government’s flagship project, ‘Quality healthcare for all’, aimed at providing high-end diagnostic tests and surgeries for free to Delhi residents at private centres and hospitals — if the waiting time is more than a month.
A soft launch for the project saw 12,000 patients across economic spectrums benefit between March and December 2017. Under the scheme, patients can be referred to empanelled private hospitals for 52 surgeries — from heart bypass to kidney stone removal, and can also approach 67 private centres for diagnostic tests such as MRI and CT scans.
While this addresses the problem to an extent, a Health department official said the fact remains that over 40% of patients at government hospitals, or about 20,000 patients daily, are from neighbouring states. “With medicines free and tests subsidised, we are getting more patients than ever. The burden on hospitals has not changed,” the official said.
In such a scenario, Delhi’s five multi-speciality hospitals — GB Pant, LNJP, Guru Teg Bahadur, Deen Dayal Upadhyay and Baba Saheb Ambedkar — either share the single MRI machine or refer patients to Safdarjung Hospital and private labs.
Sanjay Kumar, a resident of Chandni Chowk undergoing treatment at GB Pant, said, “I have been told to wait 20 days for a CAT scan. I have pain in the abdomen and it’s not been diagnosed so far. I don’t have a choice but to wait.”
In August last year, the death of an infant at Rao Tula Ram (RTR) Hospital had led to outrage as his father alleged in his complaint to the police that the baby died due to the hospital not having oxygen cylinders. While RTR hospital and several others have denied this — pointing to the fact that most hospitals now have piped oxygen supply — a doctor admitted that if there is an unforeseen rush of patients, they are occasionally asked to “hire oxygen from private companies”.
This has led to the explosion in private oxygen suppliers around hospitals. For instance, near GTB Hospital, there are at least 20 suppliers dealing in oxygen. Ajay Sharma, who runs Ajay Medicare, said, “The surge is during winters.”
To address such issues, AAP leaders said Kejriwal had in March last year ordered that medical superintendents be allowed to make purchases of up to Rs 50 lakh to streamline procurement. A government spokesperson said, “The health sector is an area of prime focus for the Delhi government and we are doing everything to ensure that it continues providing quality healthcare at affordable rates for patients.”
Out of order
It isn’t just the absence of high-end diagnostic equipment that is hampering the Delhi government’s ambitious healthcare plans. Of the 183 operation theatres (OTs) in government-run hospitals, 31 are non-functional due to the absence of equipment ranging from anaesthesiology workstations to non-installation of ACs and OT lights.
In November 2015, the CPA had received a demand of 13 anaesthesia workstations from eight different hospitals, with tenders being floated in December. But it was only in March this year that orders were placed, with a timeline of 90 days to supply the equipment. The new deadline for installation now is June 2018. A second set of hospitals sent a demand for 54 anaesthesia workstations in September 2017, which officials said would be available by December 2018.
This has led to an undesirable situation: Nine hospitals are not being able to use 22 OTs due to the absence of an anaesthesia workstation, which costs about a lakh. In six hospitals, 19 OTs don’t have OT lights, while at two hospitals, vital sign monitors haven’t been procured.
Take, for example, Pt. Madan Mohan Malaviya Hospital which, in November 2016, became the first Delhi hospital to obtain the National Accreditation Board for Hospitals & Health Care Providers certificate — something the Health Minister has said each hospital should aspire for.
But of its six OTs, four remain non-functional due to the unavailability of anaesthesia workstations, shortage of staff, lack of OT lights and the fact that for the past six months, PWD officials haven’t been able to install a central AC. Medical superintendent of the hospital, Dr Ramesh Chugh, said, “The OTs are virtually ready. We expect work to be completed by June 2018. That is the latest deadline. We asked for equipment three years ago, but we are hopeful we will be able to start working at full potential soon.”
In Deep Chand Bandhu Hospital, all six OTs are non-functional. As per government records, reasons range from the fact that PWD hasn’t finished work in two OTs, anaesthesia workstations and vital signs monitors need to be procured, and there is a shortage of specialists.
Moreover, the government has found it hard to fill positions for specialists in anaesthesia and orthopaedics due to a state-wide shortage, said officials, adding that Group B and C posts, such as OT assistant and technicians, are being handled by the Delhi Subordinate Services Selection Board. “The requisition for the same has been sent and will be filled up very soon,” said an official.
Jain flagged the delays in a file noting on April 3 and pointed out that although different hospitals had the same requirement, the CPA timeline showed anomalies. For instance, he pointed out that Deep Chand Bandhu Government Hospital was to get its anaesthesia workstation by June 30, and Madan Mohan Malaviya Hospital by December 31. He asked, “Why such a great difference for procurement of some equipment by the same agency? Instead of tendering equipment one by one, it was directed… earlier the CPA should tender for common equipment and make a rate contract.”
Health department officials, however, argued that they were bound by the system. One official explained, “This is how a government works. Procurement is always a lengthy process. Even for installing an AC, the health department has to pass tenders and that can take long. There are numerous checks and balances to ensure it works well — but not necessarily quickly.”
In such a system, the official said, ‘radical change’ is tough to implement. “Private healthcare has improved considerably because they earn a lot and invest a lot. Our aims are different — we are trying to provide healthcare for free. That doesn’t mean that we don’t improve, but it takes time.”
Speaking at the launch of a private hospital in Dwarka on April 30, Delhi chief secretary Anshu Prakash had suggested that quality of equipment often separates a “good” hospital from a “not so good” one. “The difference between a good hospital and a not so good hospital is in the quality of technical support… Another key factor is equipment… state-of-the-art equipment and equipment that is functional. In government hospitals, we have the equipment and at times it is not functional. That is where the private sector soars and we need to learn.”
Healthcare, those from the AAP admit, is also closely tied to the party’s election plans. A source in the CMO said, “The CM has made it clear this situation cannot continue. If this doesn’t get sorted out at the level of the (health) ministry, he is likely to take up the issue with the L-G’s office.” With an allocation of Rs 6,729 crore in the 2018 budget, AAP has embarked on ambitious surge before the 2019 Lok Sabha polls and 2020 Assembly polls to augment healthcare.
In February, Deputy CM Manish Sisodia had cleared 105 projects in the health sector. Key among them were the addition of 2,500 beds in existing hospitals and the creation of 97 new polyclinics at a cost of Rs 170.3 crore, to try and reduce the burden on OPDs in hospitals.
Back at LNJP hospital, Farheen and her daughter are unaware of the politics and bureaucracy behind the scenes. Hoardings and signboards with the CM’s face assure the two that the government is doing all it can to help. Although the two arrived at the hospital at 8 am, an hour before the MRI scan was to begin, the queue was already serpentine and showed no signs of moving. Although the hospital has extended its timings for MRI, running it from 9 am to 8 pm instead of closing at 4 pm, the queues haven’t got any shorter.
“We were lucky we got a date within the next few weeks. Others have got dates months away. Doctors told us there are patients who have to head to Safdarjung Hospital for treatment, but thankfully that wasn’t the case with us,” said Farheen, spreading out the blanket to sit down while they await their turn.
Deep Chand Bandhu
Total OTs: 6
Reason: PWD work pending, no vital signs monitor or anaesthesia station
Pt Madan Mohan Malaviya
Total OTs: 6
Reason: No central AC, anaesthesia workstation missing
Total OTs: 19
Reason: No MRI machine, staff crunch
Baba Saheb Ambedkar
Total OTs: 12
Reason: Anaesthesia workstation & OT lights missing, staff crunch
Total OTs: 6
Reason: Anaesthesia station & vital signs monitor unavailable
Total OTs: 23
Reason: No anaesthesia workstation
Total OTs: 16
Reason: No OT lights
Aruna Asaf Ali
Total OTs: 5
Reason: Anaesthesia workstation missing, shortage of technicians
Total OTs: 6
Reason: Anaesthesia workstation missing, no OT lights, staff crunch
Sardar Vallabh Bhai Patel
Total OTs: 8
Reason: No anaesthesia workstation
Total OTs: 5
Reason: No anaesthesia workstation
Total OTs: 18
Reason: Shortage of OT lights, OT table and anaesthesia workstation unavailable, staff shortage