District Zero: Nabarangpur’s health system that’s stretched beyond capacity

Health centres without doctors, a blood unit running out of supply, and a sub-centre with no power.

Written by Debabrata Mohanty | Updated: January 31, 2016 9:27 am
district zero, nabarangpur district news, india's poorest district, nabarangpur healthcare, nabarangpur hospitals, odisha news, bhubaneshwar news, india news The Primary Health Centre at Deobandh. (Source: Express photo by Neeraj Priyadarshi)

> A 27-day-old baby boy is branded with a heated iron nail by a quack to treat a stomach ailment. The infant survives.
> January 2016: A 15-day-old baby girl is branded with pieces of a heated metal bangle by a quack to treat a stomach ailment. The infant dies.
> January 2016: A seven-day-old baby boy is branded on the chest and stomach with a heated iron knife by a quack to treat a stomach complaint. The infant survives.

As he jostles to get inside the OPD room at the Nabarangpur district headquarters hospital, Monga Gond is hoping to get enough time to explain what is ailing his brother-in-law Jagannath Gond, who is vomiting and gasping for breath.

“I have come all the way from Raighar block, around 35 km away in the north, as there is no doctor at our Primary Health Centre (PHC),” says Gond, trying to sneak in past at least 50 others who are crowding outside the doctor’s room.

The doctor is exhausted. It is well past consulting hours — 8 am to noon — but he has no option. “If we close the OPD, the patients will vandalise the facility. Most doctors are overworked and many leave within a few months of joining,” says additional district medical officer Dr B P Purohit, in charge of the hospital.

Over the last week, The Sunday Express travelled across Nabarangpur to understand Gond’s anxiety and Dr Purohit’s helplessness, and investigate why parents still turn to quacks in India’s poorest district that ranks at the bottom on many development indicators — primarily, healthcare.

And the big picture that emerged was this: an acute shortage of doctors at all levels, from the district headquarters hospital to the 11 Community Health Centres (CHCs), from the 40 PHCs to the 289 sub-centres. And a critical lack of facilities and equipment —including just one blood bank for the entire district, located at the headquarters in Nabarangpur municipality in the southern tip.

HQ hospital: ‘Unable to perform surgeries’

In the largest government healthcare facility — the headquarters hospital — 14 of the 32 sanctioned posts for doctors are vacant. There is no specialist in medicine, ENT, surgery, orthopaedics, ophthalmology, gynaecology or anaesthesia. “We are unable to perform any surgeries except Caesarean sections at the headquarters,” says Dr Purohit.

Records show that the district has only 56 doctors on active duty from the 134 sanctioned posts. And of the 56 positions for specialists, 42 are vacant.

Watch videos: Full coverage of District Zero (App users click here)

Last year, the Odisha government appointed 370 doctors on an ad-hoc basis in the tribal-majority region, known as KBK (Kalahandi Bolangir Koraput), of which Nabarangpur is a part. But only one-third joined and that too, in non-KBK areas.

“Out of 124 posts, 104 joined in KBK areas, but Nabarangpur and Malkangiri were the least preferred choice for the doctors,” says Health Secretary Arati Ahuja. “Very often, a doctor is unable to stay at PHCs because there is no accommodation or electricity.”

CHC: ‘Just 17 units of blood’

The situation is dire at the next level of treatment — the CHCs. Ask Suren Mandal who has reached the Umerkote CHC, the second busiest government hospital in the district after the headquarters, hoping to get O-positive blood. Mandal’s brother-in-law Prakash Gain has been vomiting blood for over 24 hours and the doctor has prescribed at least four units to arrest his sinking levels of haemoglobin.

But medical officer in-charge of Umerkote CHC, Dr S C Satpathy, says, “We have just 17 units and our first priority are pregnant women from our block as well as neighbouring blocks.” Finally, he grudgingly agrees to give Mandal one unit of blood. Despite rules stating that all CHCs should have a blood bank, the Umerkote hospital has only one blood storage unit.

Officials and residents say that even if doctors do actually turn up at Nabarangpur — there are complaints of poor telecom connectivity and the nearest rail link is at Jeypore, 40 km away — many proceed on leave soon.

In the 36-bed Umerkote CHC, which caters to the over 5-lakh population of Umerkote, Chandahandi, Jharigan and Raighar blocks, the rush of pregnant mothers every day means there are at least 70 patients lodged here on any day.

“We have no option but to let many patients sleep on the floor,” says medical officer Dr Satpathy. “The hospital also needs at least 10 doctors, including two paediatricians, but there are only six sanctioned posts.” A surgery specialist was posted to the facility last month but left days after joining. And the two-year contract of the hospital’s only gynaecologist and obstetrician, a retired doctor, expired last week.

The surge of the patients to the CHC is so much that Dr S K Panda, the only paediatrician, says he has to often “sacrifice” his off days.

PHC: ‘I am useless’

The situation is equally abysmal at the PHCs, one tier below CHCs. At the four-bed Kodigan PHC of Kosagumuda, AYUSH doctor Rakesh Kumar Jali holds the fort in absence of an MBBS doctor. Sitting inside an asbestos-roofed building, Jali says, “In medico-legal cases, I am useless. I suggest medicines, the pharmacist prescribes it on paper.”

The Kodigan PHC lacks a dedicated transformer for power supply. The newly-built OPD and labour room have been lying unused due to lack of water supply. Jali functions out of the labour room.

Sub-centre: ‘Bulb in wrong location’

The situation is probably the worst at sub-centres, the lower-most tier. Catering to over 3,800 villagers, the Makia sub-centre in Papadahandi block has a labour room with a leaky asbestos roof where Auxiliary Nursing Midwife (ANM) Madhumita Das and additional ANM Sukesini Sahu perform 19-20 deliveries on an average every month.

The paediatric ventilator, set up last year, is lying useless without dedicated power supply. The solar panel on the roof is not connected to the ventilator and serves no other purpose except light a bulb in a corner.

“During childbirth at night, I bring an emergency lamp from home as the bulb lit by the solar panel is fitted at the wrong location. The freezer is also not working due to lack of dedicated power supply,” says Das.

Govt: ‘No readymade solutions’

Health Secretary Ahuja admits that the government does not have any readymade solutions as yet. However, she says, they are considering an “assured transfer policy” for doctors who serve in KBK districts for at least three years. The government is also planning to implement a “KBK allowance” of 40-100 per cent (already in place for regular doctors) of the regular basic salary for ad-hoc and contractual doctors, she adds.

“We are also planning a corpus fund at the district level through which the district collector can get houses near hospitals on rent. If we are in a position to post only five-six doctors against a vacancy of 10, the collector will rotate the doctors in the PHC or CHC and provide for transportation costs,” says Ahuja.

“The collectors will also be given the freedom to engage specialists and super specialists on contract from outside Odisha till a permanent solution is found,” Ahuja says.

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