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One of Asia’s largest TB hospital is breeding ground for infection

Stray cats stroll near patients’ bed in the wards of the Sewri TB hospital,one of the largest in Asia

Written by Tabassum Barnagarwala | Mumbai | Published: July 18, 2013 12:03:18 am

Stray cats stroll near patients’ bed in the wards of the Sewri TB hospital,one of the largest in Asia. Stained bedsheets unchanged for several days,sweepers going about their daily chores without wearing the N-95 mask,and rainwater making its way through the grilled windows,are indicative of a bigger malaise that inflicts the hospital.

Following the death of 24-year-old medical student,Dr Samidha Khandare,on June 30,the staff has hurled accusations about the shabby state of the hospital,lack of proper diet and unclean environment. Those working in the hospital allege 19 staff members have contracted TB and dozens are suffering from Multi-drug Resistant (MDR) TB.

This year,11 Extensively Drug-Resistant (XDR) patients have succumbed to the disease in the hospital’s three units — KEM,Sion and Nair (TB patients from these hospitals are shifted to Sewri,hence the units are so named).

The list of woes for Sewri hospital is long and serious. Doctors don’t want to join,it’s becoming tough for the hospital to recruit even a supervisor for its boiler that disinfects bedding and patients’ clothes,and functioning of the hospital’s new wing is stuck due to encroachment.

Difficulty in inducting doctors

The TB hospital currently houses 49 Resident Medical Officers (RMOs) and 1,200 staff members. With 750-800 patients occupying the 1,000-odd beds,the hospital is trying to cope with the increasing number of patients demanding the attention of a handful doctors. “There is a general perception that it is unsafe to work in a TB hospital. Doctors are scared of treating patients because they fear they will contract the disease. That is one major reason for doctors refusing to work here,” said Medical Superintendent Dr Rajendra Nanaware.

Plans to induct new doctors for a new wing are on. “Our request for more doctors has been sanctioned and we will roll out an advertisement for doctors soon,” he said. Currently,the hospital receives 150-200 patients daily on OPD and admits around 30-40 each day. The rise in TB cases and the death of a doctor has led to recruitment problems. However,BMC’s Additional Municipal Commissioner Manisha Mhaiskar said there is no problem in finding suitable doctors. The hospital,which treats pulmonary TB,currently houses about 31 XDR patients. It takes 6-9 months for TB patients and 2-4 years for MDR patients to be fully treated.

Disinfecting boiler not functioning

Absence of a supervisor for operating the hospital’s disinfecting boiler to clean/ wash patient’s clothes and bedding is another issue. The last supervisor died a few years ago. The boiler is used for disinfecting clothes,pillow covers,blankets and bed sheets after which they are sent for laundry.

Currently,the hospital’s bedding are sent to Kasturba hospital for disinfecting,which has created a delay in getting fresh supplies. The bedding of patients,which should be changed every single day,are changed in three to four days. Dinesh Rathod (24),an MDR patient,was admitted to the hospital three months ago. His brother Amol,who has been tending to him,said: “The staff changes the bedsheets in three-four days. Sometimes,when I find washed bedsheets kept in the ward,I change it myself because nobody comes to change it.” The bedsheets are smeared with food and blood stains. Most MDR patients said their bedsheets are replaced every three-four days.

It is shocking that for more than three years,the hospital has not managed to appoint a supervisor. Nanaware said,“For the supervisor’s post,there are a few eligibility criteria. A diploma in boiler technology is a must,besides other requirements. Till now,we have not found a suitable candidate.”

Besides this,the boiler plant is also under repair. Sandeep Rai (22),an MDR patient,said he has been admitted to the hospital for a month and a half and his bedsheets are changed only twice a week. He was wearing his own set of dirty clothes and claimed he was not provided any hospital clothing.

2012 plan to add new wing stuck

Plans to expand the hospital were first conceptualised in 2012. Development work started last September and the new wing was expected to be operational by May 2013. The work is yet to be completed.

According to BMC Chief Health officer Dr Arun Bamne,the wing will be used to accommodate MDR and XDR patients for intensive treatment. “We wanted to extend the facilities to provide better services to TB patients. Also,a segregation of MDR patients from normal patients is required,” he said.

The new unit,to be called ‘Bahadurji block’,is part of Sewri hospital’s expansion plan. The management of the hospital had decided to add 200 beds to its present 1,000-odd capacity by re-opening a unit that was shut in the 1980s due to a fall in the patient count.

“The building was earlier used to house around 1,250 women and children for treatment. During the 80s,the number of patients dropped to 800. That’s when the unit was closed and patients brought to the main hospital. Now,with the rise in the number of patients,we are hoping to re-open the unit,” Nanaware said.

The building is about half a km from the main hospital and its open area had been given to the Slum Rehabilitation Authority for a transit camp for the last five to six years. With plans of re-opening the unit,a notice was issued to the residents of Matoshri Sahkari Grahnirman Sanstha and Omkar Developers and Builders to vacate the open space on the premises.

The hospital was expected to start functioning from May,but the deadline was unofficially postponed to July 15 and now,according to Mhaiskar,the wing will be opened after a month.

Around 120-150 patients will be transferred from the main hospital to the new wing. The hospital also plans to recruit more staff. “We will be appointing six assistant medical officers,three medical officers and one honorary officer for the new hospital,” Nanaware said.

The infrastructure and civil works of the new unit are close to completion. “The electricity connection,drainage and basic utilities have been looked into. We are now waiting for the removal of transit camp from the hospital’s premises,” he said.

The hospital,which had been donated by Manekbai Bahadurji,is a ray of hope for the ever-increasing TB patients awaiting proper treatment. The continuous delay is depriving the needy of timely attention.

measures taken and planned

With the Sewri TB hospital’s functioning in the eye of a storm,the BMC has now taken a few measures to ensure its staff’s health. Instead of conducting medical screening half-yearly,since January 2012,it is conducted every three months. “Screening is done to check the health status of doctors and staff. It will help detect any disease at the earliest,” said Nanaware.

A sweeper at the hospital discovered he had TB after he was screened at the hospital. His colleague,who did not wished to be named,said: “Workers frequently contract TB. My friend is currently on leave and is expected to rejoin after treatment.”

After allegations of poor diet,every doctor and worker in the hospital is being provided with ‘sakas ahar’ before they start with their day’s activities since May 1,2012. ‘Sakas ahar’ is a protein supplement that contains 12-15 g protein and 350-400 g calories.

An Infection Control Committee (ICC) has also been set up to identify health and hygiene issues and methods to fight them. A member of ICC said,“The committee was set up in June 2011. We try to upscale the standards of hygiene by laying down guidelines in the hospital.”

Plans for new projects include a Line Probe Assay (LPA) lab and a gene expert lab. Till now,samples for detecting MDR were sent to JJ Hospital,which has a lab for testing. After the lab’s construction,testing can be done here and results obtained in two days. “The conventional method took around three months for assessing MDR samples,therefore till now we sent samples to JJ Hospital. With the new lab,the process would get simplified,” Nanaware said.

Although the hospital claims to have maintained the required standards,a visit to the hospital paints a different picture. The sweepers claimed the actual number of workers contracting TB is far greater than what the authorities quote. But the fear of losing jobs has kept them mum. One of the cleaners said,“I replaced my father’s position after his death. Since I have nowhere else to go,I have to work here even if I feel scared of contracting TB.” Another worker Firoz (24) contracted MDR in the hospital and is on leave. The new wing and launch of the coveted lab offers some hope. The state has allocated Rs 62.21 crore this year for the hospital.

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