When Syed Roshan, a construction worker, slipped from the second floor of the building site where he worked on August 9, he was rushed to at least four hospitals before he was finally admitted into Hyderabad’s Osmania General Hospital (OGH). Over four hours had passed by then since his fall. After a couple of emergency surgeries and treatment at the acute surgery care unit, the 35-year-old succumbed to trauma and multi-organ failure on August 22.
The case, however, came in focus after a photograph showed Roshan in the hospital with his left arm was stabilised using a piece of cardboard instead of plaster or splints. Doctors said Plaster of Paris (POP) was not available at the emergency orthopaedic care at that time, and the patient’s attendants were unable to buy the same from outside.
The case in point may be brushed aside as a one-off incident, but a representation from the Osmania Telangana Junior Doctors’ Association to the hospital superintendent, dated August 18, talks about the need for “provision of basic amenities in Casualty, Acute Surgical Care, and in the post-operative ward”. In the letter, which indianexpress.com has seen, doctors demand that “proper chain must be restored for providing basic essentials such as emergency intubation tray, surgical gloves, spirit, POP rolls, roller bandages, betadine, etc in the casualty, acute surgery care, post-operative ward, and plaster room.”
The doctors said they were finding it difficult to treat patients due to this sudden shortage of essentials. “For a plaster cast in case of a fracture, we would need at least five rolls. We are forced to ask patients to get them from outside. Each one costs Rs 140, and patients are unable to even afford that. On our part, we are often running around for something as basic as betadine or spirit to clean a wound,” a junior doctor told indianexpress.com.
The Osmania General Hospital is Telangana’s apex tertiary care hospital, and currently, the only non-COVID care hospital in the state capital. The Gandhi Hospital, another apex tertiary care hospital in Hyderabad, was earlier designated a ‘Centre of Excellence for COVID Care’ diverting patients to OGH. Patients, especially from underprivileged backgrounds, are dependent on OGH for all non-COVID treatment, especially surgical emergencies.
Hospital Superintendent Dr. B Nagender dismissed the claims of junior doctors as attempts to “tarnish the image of the hospital” and told indianexpress.com there was no shortage in the hospital. “These claims are absolutely wrong. The needs, if any, should be justified. We may provide according to the need of the patients. An assistant professor should oversee what is required.”
The letter also highlights non-functional oxygen portals, and lack of monitors, ventilators, oxygen portals, etc in the acute surgery care unit, and also about an emergency operation theatre (EOT) without centralised oxygen lines. Dr Nagender admits there is an issue relating to the oxygen supply. “The existing oxygen lines are very old and not uniform. That is causing variation in pressures. But, we have started laying new lines and soon every bed and OTs will have the oxygen supply. Five hundred new ports are being added.” Also, according to him, there are 140 ventilators and the ASC unit has nine oxygen ports. When indianexpress.com visited the ASC unit on August 19, only one ventilator and three functional oxygen ports were found in a jam-packed hall.
The junior doctors also expressed apprehensions over clubbing of patients from the various departments in a single hall on the fourth floor of Quli Qutb Shah building, a makeshift arrangement after these wards were evicted from the old heritage block recently. “A patient post his surgery, a trauma patient with a fractured leg, and those with general illness or seasonal diseases, or even pneumonia, are all housed in one hall. There could be some suspected of COVID-19, too. This is a high-risk scenario for all patients,” a junior doctor added. The letter also gives one week to the authorities to fix these issues and states junior doctors would be forced to boycott OPD’s and shall protest until demands are met with.
No pressure on hospital
The hospital superintendent feels the existing number of beds are sufficient. Owing to the pandemic, he said, the admissions are down to nearly half compared to the pre-COVID era. Referrals from other districts, too, are near minimum. There is no additional burden on the hospital owing to the prevailing pandemic.
According to him, the OGH used to record over 2000 out-patients. Pointing at statistics on the wall of his chambers, he says, the footfall of outpatients on August 19 was just 695. Similarly, the hospital has 1,385 beds but the number of admissions as of August 19 was only 511. A new building on the 25-acre campus that was meant to be a shelter for attendants of patients is now being considered for setting up 80 beds and establishing necessary OTs.
Old building shut down
The century-old in-patient building, commissioned by the last Nizam of Hyderabad Mir Osman Ali Khan Bahadur, took a final nail in its coffin when the ground floor of the building was flooded with rainwater and sewage on July 15. This had caused widespread outrage as patients, including those suspected of COVID-19, were housed here.
In the following days, the patients were moved to makeshift arrangements in the Out-Patient block and Quli Qutb Shah building. On July 22, the director of medical education issued orders to stop all elective procedures in operation theatres located in the old building till alternate arrangements are made. All emergency surgeries, the order said, have to be carried out in the emergency operation theatre (EOT) in the OP block.
#OsmaniaGeneralHospital‘s 101-year-old #heritage block was to be shut for renovation in January. Govt had sanctioned funds last year. Finally its closed now, patients are shifted to other buildings. Last week’s rains have expedited the process but no word yet on plan of action pic.twitter.com/BMf5UHkDEb
— Rahul V Pisharody (@rahulvpisharody) July 22, 2020
The August 18 letter to the superintendent, also requests permission to utilise the operation theatres in the now-vacated inpatient building temporarily until the provision of a new OT complex. At the moment, all elective surgeries in departments of general surgery, general medicine, and surgical gastroenterology are stopped for lack of an operation theatre and only emergency surgeries are performed.
“We are having to counsel patients and send them back. They cannot afford these surgeries in private hospitals and a delay in procedures can cause larger damage,” a junior doctor said.
Even in case of elective surgeries, he said, junior doctors are dependent on shifting the equipment every day from the old IP block to OP block, taking a good 20 minutes. “Ward boys put all necessary surgical equipment on a stretcher and shift them to the emergency operation theatre (EOT) in the OP block and after its use shift them back to the old block every day. This itself takes away the crucial time to perform surgeries,” said a junior doctor from the orthopaedics and traumatology department, who claimed only a couple of elective surgeries are performed currently at the EOT as against 10-15 a day before it was shifted out of the old IP block recently.
The hospital superintendent, when asked, said electives are stopped only for the department of general surgery and all emergency cases are taken up at the EOT. “A three-member committee is evaluating possible spaces for having OTs for general surgery. Soon, these OTs will be accommodated,” he stated.
Following the representation submitted to the hospital superintendent, a circular was issued by the HOD of Orthopaedics on August 20. It forbids all the post-graduates doctors from individually approaching the administrators regarding any issues and directs them to discuss with the duty surgical officer (DSO) or concerned chief first. “If any deviation, it will be viewed seriously,” the circular warned.
An NGO volunteer who assists the underprivileged at the hospital, when asked, said the OGH, in any case, is the saviour of the poor despite various perennial issues it may have. “Services are not optimal but it is the only place where the poor are not turned away,” he said, hoping the government would take measures to enhance patient care.
PILs in high court
With the hospital’s heritage block now shut, doctors are eagerly awaiting a judgment from the Telangana High Court which is hearing a batch of public interest litigations regarding the building. Two factions, one demanding the restoration of the heritage block and another demanding new buildings for the OGH, have been active in the past few years.
In November 2010, the state had announced an administrative sanction of Rs 200 crore for a new building. Since then, while no progress was made regarding a new building, the existing block suffered further deterioration of infrastructure coupled with official apathy.
In 2015, Chief Minister K Chandrasekhar Rao’s plans to raze the heritage building and replace it with twin towers of 12 floors each was met with severe public outcry and was shelved indefinitely. At the time, a report on the OGH by the Indian National Trust for Art and Cultural Heritage (INTACH) stated that the building was structurally stable and called for repair and restoration.
In July 2019, the state had sanctioned Rs 19.2 crore for repairs and renovation. In November, a delegation from Aga Khan Trust for Culture (AKTC) along with the state department of archaeology officials visited the hospital and inspected the building. This, too, did not materialise.