AT LEAST 15 crore people suffer from common mental health disorders in India, according to a national survey conducted in 2016 by NIMHANS, the country’s premier mental health facility. But for over 19 months, the All India Institute of Medical Sciences in Bhopal did not see a single mental health patient.
In May 2015, AIIMS Bhopal shut down its OPD for such patients — one of its busiest, it had attended to 8,452 patients since 2013 and at least 15 patients a day in its last month. Reason: all of the two professors quit, one from NIMHANS in Bengaluru and the other from AIIMS in New Delhi.
The Indian Express visited the AIIMS facility in Bhopal and accessed official records to find that the dismal state of its psychiatry department mirrors a larger problem at one of the six new such functional institutes set up for “correcting regional imbalances” in healthcare. Quite like the pile of debris lying next to the unlit corridors behind the gleaming glass and brick facade of the AIIMS building in the heart of Bhopal.
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AIIMS Bhopal started clinical services on August 15, 2012, and OPD services on January 26, 2013. Five years on, it’s yet to get a full-time director, has 80 per cent of faculty posts lying vacant, and has filled only 73 of the 327 sanctioned slots for senior resident doctors.
“Can you imagine AIIMS shutting down its mental healthcare services? In March 2015 alone, the institute attended to 1,059 patients. But within the next two months, the services were shut. In December 2016, one doctor was recruited, but that was a resident doctor and not a full fledged faculty,” says a senior consultant with AIIMS Bhopal. And this, when the NIMHANS survey dug up this ratio from Madhya Pradesh: one psychiatrist for 20 lakh people.
“For almost 15 months, patients had to be referred to other hospitals in the state or outside. When is the last time you have heard AIIMS referring patients? AIIMS is supposed to be the country’s top referral centre,” says the consultant.
That’s not all. Consider these findings:
41 depts on paper, only 25 functional
On March 2014, AIIMS Bhopal had 27 departments with 61 faculty members. And, according to official records, the institute now has 41 departments. But on ground, the number of functioning departments has dropped to 25, and staff to 59.
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For instance, the Department of Cardiothoracic and Vascular Surgery, which deals with cardiac conditions, is functioning on paper but has not attended to a single patient since June 2015. In May 2015, its only faculty, an assistant professor from AIIMS New Delhi had quit. And this, for a department that catered to 4,180 patients in the two years it functioned.
“This is a basic requirement for any tertiary care hospital but the department has been shut. We are hopeful that it would be reopened in the next few months,” says a senior official in the institute’s administration wing.
It’s a similar story at the Oncology department, where the only assistant professor who joined the radiotherapy department in July 2013 quit seven months later. The institute hasn’t provided any cancer-related services for the last three years.
Besides, AIIMS Bhopal is yet to get key departments, such as cardiology, nephrology, endocrinology, gastroenterology, urology and nuclear medicine.
Heavy load, few doctors
The Ophthalmology department operates the fifth busiest OPD at the institute, catering to 19,886 patients in 2015-16. But from May 2016 to February 2017, it has been running without a single faculty member and with just two resident doctors.
“We are one of the busiest OPDs here, which is why it’s even more important that there is at least one senior faculty member to handle complex cases. Currently, resident doctors with less than three years of experience are managing the OPD,” says one of the resident doctors.
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But what’s more worrying, say doctors, is the inadequate infrastructure. The department has only one refractionist to determine errors of refraction in the eye. “We ask patients to visit private facilities and come back to us. A single person cannot handle such a load and when this person is on leave, the department comes to a standstill,” says the resident doctor.
This lack of basic infrastructure, says the doctor, means non-availability of services. “Being an institute of national importance, we should have started cataract surgery by now under the national programme for control of blindness. But since 2015, the department has performed only minor surgeries and no major surgery,” says the doctor.
No casualty, emergency services
Five years since it began operations, AIIMS Bhopal does not have dedicated casualty and emergency services. For instance, the Orthopaedic department, considered to be emergency care department, does not have an emergency and trauma care.
“We cannot handle acute trauma cases. With the present infrastructure, we can only conduct elective surgery, which is scheduled in advance and does not involve an emergency. Even if we get a minor trauma case, we have to refer it to other hospitals,” says a resident doctor at the department.
Doctors blame the “lack of human resources and infrastructure” for the delay. “The departments of anaesthesiology and radio-diagnosis have just one faculty member each. Only if these two departments have enough resources and infrastructure, can the Orthopaedic team provide any emergency services,” says a doctor at the Orthopaedic department.
“We will soon begin casualty and emergency services on priority,” says the administration official.
Students ask: what clinical training?
If the treatment facilities at AIIMS Bhopal are far from “premier”, the teaching programme is no better. Students complain about “lack of quality teaching, faculty and infrastructure” and the “unacceptable” practice of having to “visit” other colleges to complete their clinical training.
“If this was a private college under the Medical Council of India, admission would not have taken place for a singe MBBS batch. The medical college would have been forced to shut down,” says a student in his final-year MBBS course.
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The student, who was ranked among the top five in Madhya Pradesh for the entrance exam, says he now regrets choosing AIIMS, Bhopal “over other top ranking colleges”. “The problem starts in third and fourth year, when we have to undergo clinical training. We are being taught by a senior resident with less than three years of experience,” says the student.
“For example, at one point of time, there was no faculty in general surgery and cases were referred to a private hospital. During that period, we could hardly attend to any patient here. We are basically trained to be clinicians. But since we refer patients, we attend to only minor cases,” says the student.
“Even if we have cases, we don’t have any faculty to report to. In gynaecology, we have to note the medical history of the patient and report to the faculty. But there is no faculty to tell us whether what we are doing is right,” says the student.
Other students say the lack of infrastructure has led to a “drop in the quality of clinical training”. “For instance, the blood bank has been operationalised after four-year delay. But the institute has a licence only for ‘whole blood transfusion’. We don’t have a licence for transfusion of components, such as red blood cells, white blood cells and platelets… 90 per cent of high-risk pregnancies require such transfusions,” says another student.
And yet, what students find particularly difficult to digest is the “practice of sending us to other hospitals”. “The department of psychiatry is shut for more than two years, and we have to go to other hospitals for clinical training,” says a student.
Asked what an 80 per cent faculty shortage meant for students, the final-year student says, “One resident doctor does the rounds in the in-patient department. He also teaches undergraduate students. Then he goes to the OPD, where he sees at least 35 patients. Finally, he has to supervise 20 students posted at the department,” he says.