Sick centres have little to show how the money is spent

The case illustrates the dichotomy in health care in Maharashtra. The State Government has been able to control malnutrition and malaria in rural Maharashtra. Health programmes are rapidly being introduced and implemented in rural areas. Despite this, the bewildered villager from the state touted as one of the most advanced in the country, ends up as a loser.

To the illiterate Adivasi patient, the doctor’s educational qualification is irrelevant. To him, one who is patient and understanding, and more important, who pumps him with intravenous fluids and injections is a good doctor. And the latter mind-set is a result of a trend set by proliferation of exponents of the electrohomeopathy course (BEHMS) banned by the government. (One IV unit costs Rs 15).

For instance, the health scene in Devargao and the surrounding villages (comprising 10,000 residents) is managed by a BEHMS `professional’ who says he “even conducted an eye camp recently”. Most accessible villages have self-styled physicians-cum-surgeons, some of whom are some former compounders and drivers in reality.

To counter the trend, the government has drawn Bachelor in Homeopathic Medicine and Surgery (BHMS) doctors to primary health centres (PHC). However, it is a story, again, of poor living conditions. And the medicos want out. Each district health office has been given a target of performing 1,000 sterilisation operations between April 1997 and March 1998. Only 42 have been performed in Nashik district. The operation theatre in the dilapidated Peth rural hospital in Nashik District cannot be used due to a leaking roof.

Explains V G Patil, Extension Officer, Health, “Nurses convince women with at least one son to have a tubectomy done. (Sterilisation of a woman with only daughters is unheard of). These women are taken to the Trambak Rural Hospital, 35 km away. As they cannot afford the cost this entails, they are then falsely registered as indoor patients so they can get free food.”Maharashtra has 1,695 PHCs. The ratio works out to one PHC for 30,000 people and in Adivasi belts it is 1:50,000! And these could be spread over 25 remote and inaccessible villages.

In Nashik district comprising of 1,928 villages there exist only 94 PHCs and 540 sub-centres. Model PHCs have been constructed, each having an examination room, administrative office, store-room, male and female wards, operation theatre (OT) and labour room. Except for the first two mentioned, all the other rooms are locked up or used as godowns. In most cases, the OT (where at least laparoscopies can be performed) has never been opened due to leaking roofs.

Some PHCs, like Tokada in Murbad taluka (Thane), have been constructed too far away from the villages to attract any patients. It is quite normal for a sleepy looking nurse, sometimes in her nightgown, to confront a patient during OPD hours. After the OPD, it is most likely that the PHC will be locked up. The doctor is either away at a `meeting’ or in another PHC where he holds additional charge – or, he is absconding!

At Roheli, the dubious presence of used condoms and torn `Nirodh’ packets in the backyard of the PHC raises serious questions. Villagers claimed they were unaware of, and hence could not comment on, any extraneous activities in the PHC. They alleged that as no villager ever came to the PHC and maintaining Dr Jagtap (the Class 3 MO in-charge) and his staff of 19 was a waste of public money.

The post of the pharmacist is almost never vacant as he runs the PHC in the absence of a doctor. Admits Sheikh, a pharmacist at Thanepada village, “We dispense tablets, give injections and refer the patient to the nearest rural hospital (in this case Harsul) if his condition is critical.”

The Harsul Rural Hospital in Nashik district, is run by one BHMS doctor and one nurse. The MBBS doctor and two other nurses are reported to be `absconding’ i.e. they are employed elsewhere, but have not resigned as yet. The single ambulance was sent for repairs to Nashik a month ago.

A few PHCs like those in Aasa and Ambe, operate in single or two-room sub-centre buildings used for outpatient care, blood collection, in-patient care and storage.

After a sub-centre was constructed in Devargao three years ago, no government official has visited the place. Now, cattle graze in the compound.Several of these buildings have been under construction for years. Due to difficulties in transporting construction material to the sites, contractors abandon the projects mid-way.