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Tuesday, March 31, 2020

Aam Aadmi Polyclinics: A check-up

Meant to serve as the second tier in AAP government’s ambitious healthcare reform plan, the capital’s polyclinics are trying to cope with a lack of doctors and equipment, and an ever-increasing patient influx. The Indian Express reports from two of the busiest ones.

Written by Kaunain Sheriff M | New Delhi | Updated: June 25, 2018 4:31:42 pm
Aam Aadmi Polyclinics, aam aadmi party, aap government, aap healthcare, delhi healthcare, aap opd, indian express, delhi news Patients queue up outside the medicine counter at the Aam Aadmi Polyclinic in Tilak Vihar. Express photo by Oinam Anand

It is 10 am, and 10 patients wait in a queue in the narrow passage leading to the medicine OPD on the first floor. After waiting for over 15 minutes, Saleem (30) entered the 10×10 room, partitioned in two. Saleem, who has been suffering from a chronic cough for weeks, came here after an unsuccessful visit to a private hospital in east Delhi. In less than three minutes, his consultation is over.

“The doctor gave me medicines for 10 days and said I should visit him immediately if the cough worsens,” Saleem said, rushing to the ground-floor pharmacy that has over 30 patients waiting for free medicines.

Next up is a seven-year-old boy accompanied by his mother. In under a minute, they are asked to leave. “You have been sent to the wrong OPD. Please go to the ground floor. The paediatrician will see the child,” the doctor said. The woman retorted: “We have been waiting for such a long time; why should we go?”

The doctor managed to calm her down, and accompanied her halfway to the paediatric OPD. “We need a security guard to sort these things, but there is none here,” he said. In the next three hours, the lone doctor sees at least 200 patients — including 100 at the medicine OPD — between 11 am and noon.

“Yes, that is less than two minutes per patient. With a single doctor, what can you do? Look at the empty chair — that is for a second doctor. For the last three months, only one doctor has been doing all the work. There is no consultant. Hedgewar Hospital has eight junior residents but not a single one has been assigned here. All the load is on the hospital’s eight senior residents,” the doctor said, preparing to extend his OPD timings by cutting short his half-hour lunch break.

This is just another day at the busiest OPD of the capital’s first polyclinic, located in east Delhi’s Kanti Nagar. Planned as the second rung in decentralising healthcare facilities, the AAP government had, in November 2015, converted a 30-bed maternity home into an OPD facility with multiple specialties. The polyclinic is attached to Dr Hedgewar Arogya Sansthan, and specialists from the tertiary care unit visit the facility. “This polyclinic will be a model and its functioning will be closely monitored since it will form the basis for setting up 100 such clinics across Delhi,” Chief Minister Arvind Kejriwal had said.

The AAP government’s ambitious plan was to introduce a three-tier structure and give a boost to primary healthcare. The first tier would have 1,000 mohalla clinics to address common healthcare needs. Patients with specialised needs would be referred to the second tier — the polyclinics. As per the government’s plan, polyclinics are specialist OPDs where medicine, gynaecology and paediatrics specialists are available every day and orthopaedics, eye and ENT specialists are available on selected days of the week. Close to two years later, 24 polyclinics have come up.

While many have been lauded by patients for providing an alternative to private hospitals, doctors said a lot more needs to be done. Take, for instance, these issues at the Kanti Nagar polyclinic:

Medicine OPD: The polyclinic does not have a referral system, wherein patients are referred from mohalla clinics. Instead, it caters to each case registered at the OPD.

“In the absence of a referral system, we get at least 200 patients with common cough and cold every day. These cases should be resolved at the mohalla clinics; it doesn’t require a specialist. Because of the heavy load, we cannot give enough time to cases that require detailed examination. Patients do not want to wait for long and there is constant pressure on doctors to clear cases as fast as possible. The government has to put in place a referral system,” a doctor at the OPD said.

Eye OPD: Doctors said basic equipment such as a retinoscope, which determines the refractive error of the eye and the need for glasses, is yet to be installed. “Basic facilities, like a slit lamp, are still not installed. Doctors are asked to get their own torch. A refractionist comes twice a week, but she can only examine near vision,” a doctor said.

“We see 60-70 cases of eye irritation and discharge per day. You don’t need a specialist to handle these. I come from Hedgewar hospital, and I miss 15 cases in the operation theatre… With very little resources, we end up referring patients,” the doctor said, adding, “Eye drops for lubrication are essential at the OPD but the pharmacy doesn’t have them.”

Orthopaedic OPD: This OPD, which sees 175-200 patients a day, lacks an X-ray machine and a physiotherapist. Even plaster of Paris, used for fractures, is not available. Highlighting the lack of essential medicines, the doctor said, “The OPD gets a lot of cases of lower back pain. However, the list of drugs we prescribe does not have the muscle relaxant, methocarbamol — used to treat skeletal muscle spasms. So we either refer patients or give them a painkiller. We have been given a list of 10-12 medicines and we keep repeating them,” the doctor said.

Paediatric OPD: This polyclinic used to be a maternity centre with in-patient services that are now shut. This has affected the paediatric OPD. “I was a specialist here when the maternity centre was fully-functional, with five senior residents. We used to handle at least three-five neonatal cases daily. Now the services are shut, but I have not been transferred. Cases at the polyclinic can easily be handled by resident doctors,” the consultant said.

Asked why a consultant is not needed at the polyclinic, he said, “Specialists need at least five minutes to examine the patient. Here, I see 150-230 patients a day. There is not enough time. With limited tests, you are killing the skill of a specialist. I have written to the government about the workload at the OPD. It is affecting my mind. I have asked for a transfer.”

Despite the teething issues, most patients said the polyclinics are a boon. “I came here after visiting a private clinic. The medicines are available free of cost. It is a big thing for us. At private clinics, the same medicines cost Rs 200,” said the mother of seven-year-old Shaista, who was at the OPD.

Tilak Vihar: The water issue

In the middle of west Delhi’s Tilak Vihar — a resettlement colony for those displaced during the 1984 anti-Sikh riots — is a homeopathic dispensary which now functions as a polyclinic. Two large bins meant for medical waste lay next to chairs for patients on the ground floor. “For the last 10 days, there was no one to clean the premises; the staff was doing it. New contractual staff have been appointed just today,” explained an official.

This polyclinic is one of the 20 launched by the AAP government to mark one year in power. While it provides eight specialities at its OPD, doctors said there is scope for improvement. One of their chief issues is lack of water supply from the Delhi Jal Board. The polyclinic currently uses groundwater.

“Doctors carry bottles from home while there is a water dispenser for patients. But the real problem is that surgical instruments, mostly ones used in gynaecology, are getting corroded by hard water. Officials said a connection has been sought from the DJB, but nothing has been done so far,” a doctor said.

Two key machines required for blood examination have been out of order for almost a year. “These machines were being used for liver and kidney function tests. Many reminders have been sent to the government, but we are still awaiting the new machines,” a doctor said.

“We are supposed to be the second tier but we still don’t have thyroid and lipid profile blood tests,” he added.

Here, too, the patient feedback was largely positive. “I had to wait for over an hour but I am satisfied with the services. The registration is smooth and I received all medicines,” said Nasreen Begum (41), at the medicine OPD. Another patient, Amarjeet Kaur (61), said, “There was a long line but the doctor instructed that a senior citizen be allowed after every three patients. So I didn’t have to wait for long.”

‘Patients satisfied, but scope for improvement’

The medical officer in charge of the Kanti Nagar polyclinic admitted that the facility requires more doctors to handle the patient load. Dr Farheem Akhtar said services such as X-ray and ultrasound are “still pending”.

“We see 850-1,000 patients a day and need more doctors. The government could appoint doctors on a shift basis as it very difficult for one doctor to handle cases. We have two pharmacists and we need three more. X-ray and ultrasound were proposed when the facility was started. Due to various reasons, it is still pending. The file has moved and we will have all tests and investigations under one roof,” he said.

Dr Akhtar added, “With available resources, we are able to provide medicines. In case we do not have the facility, we refer them to Hedgewar Hospital. The increase in OPD numbers show patients are satisfied with services.”

At Tilak Vihar, the medical officer said, “When the polyclinic opened, no one knew how many patients to expect. We are getting at least 600-800 patients a day. Once all mohalla clinics are set up, a referral system should be put in place. The next step is to appoint doctors as per patient load. The government’s focus should move away from OPD numbers to increasing the number of doctors. Also, the facilities must be augmented. The secondary tier is still at a nascent stage. It is a learning process. Once the referral system and facilities are in place, the secondary tier will reduce burden on hospitals. This will take three years.”

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