Updated: June 25, 2018 4:12:25 pm
A 40-year-old man is busy installing tiles on the floor. Next to him, a 46-year-old woman mixes cement and sand. The site is littered with fragments of stone, brick and construction dust. This is also the spot where 14 men are lying on beds, having undergone surgery recently. Some have deep wounds and, in the absence of a respirator, are at greater risk of disease and infection. This is the male surgical ward number 5 at Delhi’s Hindu Rao Hospital — the largest hospital run by the North Delhi Municipal Corporation.
The situation is equally bad, if not worse, in the female surgical ward, where broken windows mean free access to mosquitoes and outside air. An 18-year-old woman, who has just undergone abdominal surgery, lies in the middle of the cement and tiles. “They told me they provide free treatment, but now they have asked Rs 3,500 for a CT scan. I had to borrow the money. But look at this, my daughter is lying inside and I have to wait outside because of the construction. Is this how you treat poor patients?” says the woman’s father.
For the last three years, amid public outcry over the MCD’s lack of preparedness to tackle dengue and chikungunya, the state of primary and secondary healthcare services provided by municipal corporations appears to have escaped scrutiny. “Patient care has never been a priority. Yes, we are putting patients at a higher risk of infection when they are provided treatment in such conditions. But for municipal corporations, these are purely administrative decisions,” says a senior doctor posted with the emergency services, who did not wish to be named.
With more than 900 beds, Hindu Rao Hospital sees over 5 lakh patients in its OPD and conducts more than 18,000 operations every year. In the last three years, however, it has faced an acute staff crunch. “Not one resident doctor has been recruited on a permanent basis in three years. Everyone here works ad-hoc. This is one of the largest tertiary care set-ups in the capital, but you’ll be shocked to know that most of the resident doctors work on a 72-day ad-hoc basis,” says a senior doctor. “The Medical Council of India had pointed out these lacunae, but no lessons have been learnt and the entire system works mostly on contractual basis,” he adds.
Officials say this translates into a shortage of 25-30 per cent for senior and junior residents, and 15 per cent for senior consultant doctors.
A walk through the emergency and casualty services shows how the shortage affects patient care. Over 2 lakh casualty patients, mostly from the low income group, visit the hospital every year. Its emergency services — meant to address accidents and trauma — make it one of the busiest in the capital. But for over a decade, the hospital has never had a neurosurgeon, considered the backbone of emergency services.
“If a patient walks in with a head injury, the doctor here can only perform a physical examination and CT scan to assess the nature and severity. There is no neurological exam because the department does not have a neurosurgeon,” says a doctor.
“Most road accident cases have head injuries and often there are complications. We have to refer the cases to other hospitals even though the delay can cause irreparable damage,” says the doctor.
Dr Ajit Kumar Goyal, Medical Superintendent, Hindu Rao Hospital, said, “We have repeatedly written to the MCD to appoint all contractual employees on permanent basis. The proposal is lying pending before the administration. But I have heard that it will be accepted soon .”
Neglect by authorities is also evident in the dilapidated condition of the emergency operation theatre. “Walls have not been painted, window panes are broken and only fixed temporarily. The condition of toilets for doctors inside the OT is pathetic. Even the OT table needs repair. Air conditioning was provided just a week ago — that too after doctors went on strike,” a doctor says.
Here, too, patient care is compromised. For example, a basic drug required for general anaesthesia is not provided, and patients are supposed to get it from outside. “There’s a standby drug that’s used when the patient is intubated and put on general anaesthesia. It costs just Rs 60, but we have to tell patients to get it from outside,” says a doctor.
A 35-year-old man, who has come to the hospital complaining of breathlessness, says he has not been provided “any medicines”.
“I was referred from the emergency to OPD. There, they asked me to purchase medicines from outside. I don’t have enough money; now they have told me to come next week,” he says. The doctor explains, “Most of the time we provide medicines for free, but sometimes there’s a shortage.”
The critical care unit is similarly ill-equipped. Officials say the hospital is yet to get a Cath Lab — a room in the hospital with diagnostic imaging equipment to visualise arteries and chambers of the heart and treat abnormalities. “It’s essential for various cardiac procedures,” says a doctor.
The staff shortage is most visible in general wards. “For 30 beds, there is just one junior resident. If there is an emergency at night, he has to handle it by himself. In some circumstances, he has to prioritise who to treat first,” says a doctor posted in the general ward.
Being an ad-hoc doctor also means they are not entitled to basic allowance and are even denied maternity leave. “Senior residents have teaching responsibilities. The hospital does not even provide book allowance for residents; we buy them ourselves to teach graduates. How do you expect to produce quality doctors like this?” says a doctor.
“A senior resident who worked for three years was denied maternity leave; the matter is pending before a tribunal. The question is, if you can’t look after doctors, how will you look after patients?” he adds.
As he walks off for a coffee break after a 12-hour shift, he adds, “My salary has been delayed by two months. I have rent, EMIs to pay and a family to look after. Last year, I had only Rs 500 left after salary was delayed by six months. I don’t want see such a day again.
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