A six-month pregnant Saili Pawara had to undertake an arduous two-hour trip to Nandurbar, navigating through the hill ranges of Akkalkuwa, just ensure that her family doesn't have to shell out money for her ultrasonography during her pregnancy. Like Pawara, thousands of other tribals in Nandurbar district, which is spread over 5,000 sq kms are forced to undertake this trip to Nandurbar city, to access services like medical imaging to diagnose diseases and get guidance on their treatment. The tribal-dominated region ranks lowest in the human development index in Maharashtra. The district has only one government-appointed radiologist located in Nandurbar city for the entire district. The paucity of radiologists in state-run hospitals is being blamed on the disinterest of many doctors with specialisation in radiology in working in remote districts at a salary of Rs 75,000 per month. As advised by her doctor, Saili underwent an ultrasound fetal scan in her first trimester in Akkalkuwa. But it cost her Rs 1,500, which was for a family whose monthly income is less than Rs10,000. “My first child died due to pregnancy complications. This time we didn’t want to take a chance. But it was too expensive for us to do the test in private labs,” said Saili, whose husband repairs phones at a store for a living. To avoid the hassle and monetary burden, she ultimately didn't go for the scan in her third trimester. Ultrasound is essential during pregnancy to ascertain the health of the baby. It helps conform the baby's growth in the uterus, the heartbeat, movement of arms, legs and helps detect many possible congenital diseases. To make it accessible to patients, the district health department is in the process of setting up government–run ultrasonography facility in five talukas including Akkalkuwa. The rural and sub-district hospitals will have these facilities. The machines have been procured, but the district has no radiologist to do the scans. “We have floated two advertisements for the posts, but there is no response. The district has only one government radiologist,” said district civil surgeon Dr Charudatta Shinde. For most people the scans are unaffordable, but despite the hardship they still flock to the civil hospital to undergo it free-of-cost. This has overburdened the sole radiologist at the hospital, who runs over 65 ultrasonography tests daily along with monthly 400 CT scans and more than 1,000 x-rays. Some days, even at night during medical emergencies, he has to be called back for scanning. In fact, the hospital has also trained gynaecologists to scan patients but is beyond their expertise. The government sanctioned salary for a radiologist at the district is Rs 75,000 per month. But most doctors prefer private hospitals or nursing homes where they are paid an average of Rs1 lakh a month. A medical student pursuing radiology in Mumbai explained that other than the low salary, the lack of infrastructure at hospitals also deters them from applying. “The hospitals don’t have medicines to treat patients. And if any critically ill patient dies, the locals blame the doctor and start assaulting them. They don’t even have guards to protect the doctors,” he said. The district health department, left with no option, has sought help from Indian Medical Association (IMA). They have also requested the state’s public health department to make an exemption and sanction a salary of Rs1 lakh. “Pregnant women and even aged patients have to travel 100 kms for scans. Taking advantage of this, often private medical facilities overcharge the patients,” said a senior health officer from the district. This forces tribal patients like Saili to avoid the ultrasound scan which often leads to complications during pregnancy. According to data procured by The Indian Express, as many as 956 stillbirths (death of a baby before or during delivery) were recorded in Nandurbar in five years, between 2017 and 2021; with 1,698 infant deaths (death of a child below one year) during the same period. The district witnessed 37 maternal deaths, five in Dhadgaon taluka and seven in Nandurbar taluka, in 2021-22. “With a scan in the early days of a pregnancy, like 11-14 weeks, major fetal structural abnormalities, and other anomalies, can be detected easily. But since most women don’t undergo the scan, incidences of stillbirth or complications during pregnancy is quite high among patients who come to the civil hospital,” said a doctor from the hospital.
