At the rural hospital in Junnar, 21-year-old Swathi Kavthe from Kopare village was directed to Manchar’s 100-bed sub-district hospital for a cesarean delivery. “There was no medical superintendent at the rural hospital and since I had twins, they told me to go to Manchar for a C-section,” Kavthe said.
While she delivered twins, both underweight, the hospital authorities at Manchar had to call in a radiologist from a private hospital for an emergency sonography. The reason: the 100-bed hospital has no radiologist, an outdated ultrasound machine, one gynaecologist and one paediatrician.
“We conduct nearly 150 deliveries every month. At least 200 ante-natal care (ANC) women are counselled and treated every week,” said Dr Seema Deshmukh, Medical Superintendent, sub-district hospital, Manchar. “We require an ultrasound machine and have only recently tied up with a sonologist from a private hospital to attend to our women here,” she said.
While 15 posts are sanctioned, the government has been able to appoint only one gynaecologist, one paediatrician and two anaesthetists. “A total of seven regularly appointed staff is functioning round the clock to attend to an increasing patient load,” Deshmukh said. “In August, we had 61 normal deliveries and 34 C-sections. For all these, we had to call a radiologist from the private hospital,” a doctor said.
While a 12-bed special nursing care unit (SNCU) is being set up to manage critical babies, hospital authorities said the serious cases were sent to Sassoon general hospital or Aundh general hospital, which is another 65 km away from Pune. With no manpower to handle patients who come from far-off places like Shikrapur, Junnar and Narayangaon, there are homoeopaths and ayurved practitioners, who have been appointed on a contract basis to manage the patient load at the Out Patient Department clinic.
“In August, the OPD had 832 patients and another 553 were admitted to the in-patient department. We try to provide the maximum care and have conducted 88 major and 63 minor surgeries last month,” Deshmukh said. The shortage of doctors is not just limited to Manchar.
Across the state, there is an acute shortage of gynaecologists, paediatricians and other specialists across government health centres. Dr Satish Pawar, Director of Health, Maharashtra, admitted that at least 1,200 posts of medical officers are vacant from among 7,270 sanctioned ones.
There are 360 rural hospitals, 58 sub-district hospitals that have 50 beds each and another 26 sub-district hospitals that have 100 beds each. There are four 200-bed general hospitals, 23 district hospitals and 12 women’s hospitals. For 30 beds, there is a requirement for three specialists, eight specialists for 100 beds and so on.
“We need 3,087 specialists and so far have been able to appoint 2,399. The vacancies are mainly for specialists like gynaecologists, paediatricians, radiologists, anaesthetists, psychiatrists and even Preventive and Social Medicine (PSM) experts. Out of 555 posts of gynaecologists, a total of 128 are still vacant while 351 out of 584 sanctioned posts for anaesthetists have to be filled,” Dr Pawar said.
To meet this shortage, the state has even invited doctors from private hospitals to join them by offering salaries ranging from Rs 60,000 to Rs 1.2 lakh per month. “In case they do not want to join us we have offered them cash incentives starting from Rs 4,000 to conduct a single C-section. Doctors studying for PG courses have even been offered six increments at the entry level,” Pawar said.
While these efforts have yet to find substantial takers, the state health department has tied up with the College of Physicians and Surgeons (CPS) to conduct postgraduate medical courses at district hospitals. “Last year, all our 150 seats were filled but this year due to the eligibility criteria for a minimum of 40 per cent marks as per the National Eligibility cum Entrance Test (NEET) for admission to medical courses, few seats could be filled,” Dr Pawar said.
While Dr Pramod Jog, former national president of the Indian Academy of Paediatrics who is also a part of the state expert committee on neonatal care, said there was a need for infrastructure and manpower, in Pune an effort is now being made to set up a city-based neonatal network. Dr Umesh Vaidya, Associate Professor of Neonatology at the state-run Sassoon General Hospital, is guiding this neonatal network, which envisages tie-ups between public and private hospitals and supported by charitable organisations.
At least 250-300 babies are admitted every month to the 59-bed Neonatal Intensive Care unit at Sassoon General Hospital. This is level 3 care unit, which has the maximum load, and to ensure that all sick babies need not go all the way to Sassoon General Hospital, tie-ups are being made with the Pune Municipal Corporation-run four major hospitals — Kamala Nehru, Sonawane, Dalvi and Rajiv Gandhi hospital.
Special nursing care units will be designed so that they function as level 2 care units. Ritu Chhabria of Mukul Madhav Foundation and the city-based Shreemant Dagdusheth Halwai Ganpati Mandal Trust have agreed to support this neonatal network while the state-run Emergency Medical Services (EMS) ‘Dial108’ ambulances play a crucial role to ensure critical babies are saved on time. Plans have already been discussed for setting up the network which is likely to be ready by February next year.