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Thursday, February 27, 2020

One doctor, 483 patients — a day at Dhadgaon rural hospital

Situated in Nandurbar, the northern tribal district of Maharashtra, the government hospital has had seven of eight posts for doctors vacant for a month. The only doctor left, an MD in gynaecology, is on duty for 24 hours, seven days a week.

Written by Tabassum Barnagarwala | Published: September 5, 2019 4:58:39 am
Dr Santosh Parmar at Dhadgaon Rural Hospital. (Express Photo)

LAST MONDAY, Dr Santosh Parmar, the lone doctor at Dhadgaon Rural Hospital, consulted 483 patients. They included a person suffering from snake bite, an epilepsy patient and a woman who underwent an abortion. He also delivered five babies and conducted autopsies on the bodies of two boys who died of snake bites.

Situated in Nandurbar, the northern tribal district of Maharashtra, the government hospital has had seven of eight posts for doctors vacant for a month. The only doctor left, an MD in gynaecology, is on duty for 24 hours, seven days a week.

The Dhadgaon rural hospital is located strategically — it caters to 150 villages spread across hilly terrain, some as far as 30 km away. The hospital records 160 deliveries a month and Parmar conducts most of them with the help of 10 nurses. Every day, 350 to 400 patients visit the 30-bedded hospital for fever, sickle cell, snake bites and cold. A dearth in doctors has forced patients to queue up and wait, sometimes for over six hours, for their turn.

Earlier this year, the state government had begun a mega recruitment drive as the health department had the maximum vacancies (10,568 posts) in primary health centres and rural and district hospitals. The dearth of specialist doctors in tribal regions had forced the government to announce lucrative packages, allowing private doctors to negotiate their salary — as high as Rs 2 to 3 lakh per month.

Initially, gynaecologists, paediatricians and anaesthetists showed interest. “But it fizzled out eventually,” said Dr Raghunath Bhoye, the Nandurbar civil surgeon.

Since July 28, after multiple doctors resigned, Parmar has been holding the fort alone at the Dhadgaon hospital. His day starts at 8.30 am when he takes a round of all the wards: there are 10 patients in the postnatal ward, two in the casualty department, three in the general ward and two due to deliver on Monday morning. At 9.30 am, he visits the out patient department, where a queue snakes out into the narrow corridor, spilling out of the hospital gates.

With the bodies of two children who died due to snake bite, Chetan Salve said he tried to push through the crowd but could not reach the doctor’s office. “Hundreds were waiting to see him. Finally, I called him on his mobile and waited till afternoon for the postmortems to be conducted,” Salve said.

A little after 3 pm, Parmar had managed to consult 483 patients, of whom 13 required hospitalisation.

“When the patient load gets unmanageable, I have to request doctors with Rashtriya Bal Swasthya Karyakram to help me,” Parmar said. This, in turn, means RBSK doctors would have to abandon their routine duty of field visits.

By evening, Parmar visits the nutrition rehabilitation centre that manages malnourished children. On Monday night, his work was far from getting over. The first emergency came at midnight — a woman had suffered a snake bite and was experiencing respiratory distress. Two hours later, a child was rushed with a foreign object in his nose that had to be surgically removed.

At 4 am, a woman came with severe bleeding due to abortion.

“It is hard to see a patient die in front of our eyes. I have to tend to every case. If something wrong happens, we are answerable,” he said. He has been on duty for over 50 hours when he meets The Indian Express.

Bhoye said he is aware of the issue. Doctors, he said, are unwilling to work in remote tribal regions. “We had posted temporary doctors, but a month ago, the government released an advertisement for permanent postings. All doctors in our rural hospital quit to apply for that post,” he added. The Nandurbar collector’s office will soon give fresh advertisements for doctors, but these will only be temporary postings.

The hospital has only 10 beds in the gynaecology section, and the construction of a 60-bed women and child hospital in Dhadgaon remains delayed. While a woman should ideally be kept in the hospital for three days post-delivery, they have to be discharged immediately after childbirth to make space for the next patient.

Multiple letters have been written to the district administration, requesting urgent appointments. With no anaesthetist, caesarean deliveries have become impossible.

The lack of paediatricians forces Parmar to refer critical children to Nandurbar civil hospital, two hours away. The hospital also does not have a permanent medical superintendent, a non-communicable disease doctor or a National Health Mission doctor.

After The Indian Express spoke to the civil surgeon last week, a new appointment was made but the doctor is yet to join. The civil surgeon said an anaesthetist has also been appointed, but he remains on leave.

The state government had approached Indian Medical Association and various Gynaecology associations but few doctors showed interest in coming to Nandurbar, said officials.

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