SOS

8220;Most people come through a small side gate and others just jump over the gate,8221; says an apologetic Veer Singh.

It8217;s 9 am and already the queue of patients is long. Old and young, men, women and children8212;all suspected of Chikungunya or infected with the malaria-causing Plasmodium vivax or the more dangerous Plasmodium falciparum parasites8212;crowd into the small verandah outside the PHC.

As the mosquitoes got the country8217;s health officials scurrying with reports of Chikungunya and dengue making it to every media spotlight, an anonymous PHC geared up to cope with the fever that has gripped cities and villages alike. There are thousands queued up in hospitals in Delhi and in other cities, complaining of deficient services, decrying the government8217;s lack of preparedness in countering the winged disease carrier, their complaints highlighted on television and newspapers. But here in Panwari Haat, there is no time for grumbling. Even the presence of a doctor is a blessing.

Viral fever8212;with symptoms close to that of Chikungunya8212;has spread across all districts in Madhya Pradesh. Every household in the area has reported at least one case of viral fever. Dengue has already hit the state leaving the public healthcare system overloaded. While district hospitals like those in Shivpuri, Guna and Gwalior are dealing with several hundred cases every day, there is no testing of samples due to the absence of virology labs. Samples will soon be sent to Delhi and Pune labs, assure officials.

Here in Panwari Haat, says Mahesh Kumar Sharma, the health worker who has been dressing wounds at the PHC for years now, the crowds are just beginning to swell.

8220;The number of patients has increased in the last two days. We finally have a doctor at the PHC after five months and the news has spread to neighbouring villages. Patients are trooping in with fever from all over the area,8217;8217; says Sharma escorting us to the Block Medical Officer8217;s room.

Dr Rakesh Singh Baghela, 26, is busy prescribing medicine to villagers. 8220;After two years a proper doctor has come here. While the doctor before this new one hardly came to this PHC, Baghela stays in the residential quarters allotted to doctors. So for the last two days, the PHC has had a doctor for all its working hours: from 8 am to 1 pm and then 5 pm to 6 pm. Before this, the compounder and the dresser Sharma gave us medicine for that terrible fever that has hit all families in Panwari,8221; says Bhanwar Singh Murari.

Patients lie outside the compounder8217;s room on three uncomfortable benches. The remaining sprawl on the floor and still others spill on to the verandah outside. A nurse vaccinates some patients in a bare room before telling another woman to lie down on a tiled slab where she is given saline drips.

8220;She is seven months pregnant and has now come down with high fever. She cannot be given too many paracetamol tablets. The doctor has prescribed some mild medicine for her. Looks like malaria but there is no way to check since we do not have a pathologist here. We do send blood sample slides to the Aron Community Health Centre at times but they never give us any test results. So even malaria patients are given treatment according to the doctor8217;s diagnosis. We have a microscope but who will operate it without any technician around,8221; says Nurse Sushma Kujur.

Dresser Sharma and the PHC chowkidar pull out a cardboard box from the top of an almirah. It opens to show a microscope that has remained unpacked since 1997 when this PHC was opened to public.

Sharma proudly shows off the only equipment at the PHC.

8220;This is the only equipment the PHC has but unfortunately we do not know how to use it. We do not have any refrigerator or even telephone here or even syringes for that matter. Patients have to buy it themselves. The new doctor is preparing a list of things we need,8221; says Sharma.

But for many patients, the missing infrastructure is not a pressing concern. They are happy to have a doctor at last. Says Ram Swaroopa, a patient, 8220;At least the PHC is open. They give free medicines that make us well. I went to a private doctor and he gave me an injection and some tablets but my fever did not come down. Yesterday, I came when I heard of a doctor here and he gave me medicines. I am much better now.8221;

At noon, the crowds begin to thin in the Block Medical Officer8217;s room and the doctor has finally some time to talk.

I joined duty just two days ago,8217;8217; says Baghela. 8216;8216;The situation is quite bad with 50 per cent patients suffering probably from Chikungunya. But the numbers are finally declining here. There are more cases of malaria now. I have seen several patients in the last two days with complicated cases of malaria due to wrong medication. Our workers are asking people in other villages who have fever to come here for a checkup,8217;8217; says Baghela.

The doctor, just back from a stint at a PHC in Champawat district in Uttaranchal, can8217;t hide his disappointment over his current workplace. 8220;This PHC is in a really bad shape. We are meant to be treating some 25,000 people in the area, but the equipment, services, staff here are as good as non-existent. We have no syringes, no refrigerator to store medicines, basics like eye and ear drops. Forget equipment like X-ray machines or a baby warmer for the maternity ward, we are even short of medicines including life saving drugs. We do not even have a genset/inverter for emergency electricity supply,8221; he says.

He shows us a list of things he needs for the PHC and which he will be soon sending to the district health authorities: 8220;This list is of the basic stuff that is needed and that I have found acutely short in the last two days. Most of our medicine stock will not last longer than a week. We have no gloves or syringes, and just some 1,000 tablets of paracetamol when so many fever cases are coming. Looks like we will have to buy some medicines from our own money.8221;

8220;In order to ensure decent health services here we have to get adequate medicine stock, proper equipment for the PHC and its maternity ward which opened recently and is using a bulb to warm up the newborns in the absence of a baby warmer. We also need an ambulance for emergencies, 24-hour electricity and water supply and more staff. At present, we have a staff of eight against some 200 OPD patients per day from some 26 villages. This staff includes the doctor, a compounder, a dresser, a ward boy, a sweeper, a woman health worker for the field, two women nurses who do alternate night shifts so only one is at work every day and one male worker. We need one staff nurse and a technician at the earliest and one more doctor to handle extra rush and emergencies,8221; adds the doctor.

Baghela has a long wishlist which he stresses is 8216;very modest8217;. After reading it out he returns to his residential quarters for his afternoon break. The PHC closes at 1 pm, to open again at 5 pm.

A small compounder8217;s room stands opposite the dressing room where vaccinations and first aid are given. The Block Medical Officer8217;s room is next to unused vaccine rooms, a storeroom where the microscope and some analgesics are piled, two empty vaccine rooms where earlier the compounder and dresser slept at night. The maternity ward has just one bed. In all there are 8 beds at the PHC of which only the maternity ward room is open all night.

Since the centre has no refrigerator, the vaccines come from Aron8217;s community centre and so can be stored only up to two days. There are no disposable syrines here either8212;villagers get their own syringes, buying them from neighbourhood quacks. The PHC desperately requires repair, ten years after it got is first and only whitewash. For water supply, it depends on a motor installed by a tribal girls hostel. While patients sit here waiting for hours, the few fans installed here work now and then when electricity supply comes in erratic intermissions. Drinking water is available only to a few guests8212;like us.

The last bundle of cotton and the last carton of saline are open-ed before us at the PHC at 5 pm.

The patients begin trickling in again. For patients such as Parbat Singh Chaurasia from one Newoda village, the wait is over. 8220;Suna hai doctor aa gaye aakhir8230;hamein teen din se bukhar hai Heard the doctor has come here finally..I have fever since the past three days,8221; says Chaurasia.

The queue is in place. Binod, 13, complains to Baghela that his fever is still there after 15 days and a trip to a private doctor at Aron. The doctor prescribes daily injections of chloroquin. It is malaria. 8220;Maybe falciparum8230; we have no testing facility, so we depend on clinical diagnosis. I will add falciparum kits to the list,8221; says the doctor.

In between examining patients, he says how young doctors like him often quit PHC jobs because they are always on contract and never made permanent and more importantly never given extra allowance for going into the interiors.

Coming from a doctor who left a job in Delhi after his JR fellowship at the Guru Teg Bahadur Hospital to go to a remote PHC in Uttaranchal and now in Guna in Madhya Pradesh he did his MBBS from Gwalior, perhaps those formulating primary health policies should listen to his suggestions carefully.

Maybe then 26 villages and 30,000 people won8217;t have to live with a PHC without essential medicines and syringes for another ten years.

What the doctor has ordered

2 blankets 4 at present
12 bed sheets 2 at present
4 mattresses 2 at present
1 oxygen cylinder none at the PHC
100 Chloroquine doses
100 Avil doses nil at present
50 crates DNS
1000 bottles Saline
10,000 tabs Paracetamol
10,000 tabs multivitamins
5,000 Ciploflaxin
10 bundles of cotton
1,000 eye drops none at present
500 eardrops nil at present
4 big scissors
5,000 syringes nil
4 bottles of Phenyl 1 at present
Gloves nil
100 IV sets nil at present
Emergency kits
Antibiotics
Case strips to stop bleeding