In Muzaffarpur’s health care tragedy, the eyes don’t have it

MUZAFFARPUR: The hospital records get his name wrong -Mushul Darzi instead of Mohammad Muslim Darzi. The one word they get right is crucial to his identity – Darzi means tailor. He is 60 years old, from the village of Mahant Maniyari, 15km away from the district headquarters of Muzaffarpur. On November 22, Darzi was one of 65 people that came to the Muzaffarpur Eye Hospital for a cataract surgery. Since then, he has had purulent discharge and pain in his left eye, and now fears that he will lose his vision, and his livelihood. Two weeks later, his sewing machine lies in a corner of his one-room home, quietly gathering dust.

Darzi is not alone in his suffering. The eye camp at the hospital has left 30 people suffering from endophthalmitis, which is an inflammation of the eye caused by a bacterial infection from a botched cataract surgery. At least 15 of them have had to get one of their eyes “eviscerated”, which is the surgical removal of the eye’s contents, leaving the scleral shell and extraocular muscles. Darzi is one of those under medication – he has both eyes, for now.

“All I want to do now is to stay home and stitch clothes with whatever vision I have left. I need to earn money so my family can eat two square meals a day,” said Darzi, the sole regular bread earner of the family with a 58-year-old wife Aisha Khatoon, a differently abled son Mohhamad Jalaluddin, 34, who works occasionally at a private tent house, daughter-in-law Sabrunnisha, 30, and four grandchildren.

The tragedy in the last week of November has put the spotlight on Bihar’s health care apparatus, with ill-equipped government structures, a burgeoning private sector that openly flouts norms of safety, and patients such as Darzi who are caught in between, often with dire consequences.

At 77.6%, the share of households that do not use a government facility when sick was the second highest in Bihar – it was the highest in Uttar Pradesh – at the time of the 2015-16 National Family Health Survey. 60% of people who did not use government facilities reported ‘poor quality of care’ as a reason, the biggest reason for the state among five options given to respondents.

Trust deficit

Immediately after the events in Muzaffarpur, the Bihar government offered Darzi and the other victims of endophthalmitis free treatment at the Indira Gandhi Institute of Medical Sciences (IGIMS), a multi-discipline super specialty government health care centre in Patna. The risk to his eye and livelihood notwithstanding, Darzi does not want to go to a government centre. He does not believe he will come out alive.

“I know any further delay can lead to loss of vision in one eye, but I am not going to any government health care centre where they may take out my eye, or anything else can happen. I am not sure if I will return. I have a responsibility to marry my granddaughter Roshan Khatoon, who has turned 17,” said Darzi.

The fear comes from lived experience. The first time Darzi went to a heath care facility for treatment to his eye, it was a private institution, Lahan Eye Centre at Harisabha Chowk in Muzaffarpur in May 2020. The procedure, on his right eye, went smoothly but cost him ₹11,000. But Covid had hit business, and when Darzi wanted another cataract procedure, this time on his left eye, he went to what he believed was a “semi-government” centre.

He had two reasons to believe that the Muzaffarpur Eye Hospital had government linkages. First, its website mentions the Tirhut divisional commissioner as the president of its managing committee. Second, the government, until recently, reimbursed the hospital ₹2,000 for every cataract surgery done free of cost under the National Programme for Control of Blindness and Visual Impairment (NPCBVI) before the pact ended in March this year.

In truth, the Muzaffarpur Eye Hospital was founded by Sant Shree Biragi Baba as a charitable institution in 1973 under the Societies Registration Act, and it is managed by a committee headed by the commissioner of the Tirhut division as ex-officio president.

On November 22, Darzi was charged only ₹50 for registration, and ₹30 for a blood sugar investigation. In less than a week, however, he and 30 others were battling for their eyesight.

Government action

The government ordered the closure of the hospital OT on December 4, lodged an FIR against the hospital management, including the doctor who operated on the patients, and instituted government inquiries. The police complaint names 14 accused, but no arrests have been made yet.

The government also instructed all districts on December 2 to refer those facing post-operation complications to IGIMS for further treatment. “We sent patient lists to districts and advised civil surgeons of Muzaffarpur, East Champaran, West Champaran, Sheohar and Samastipur, to track the patients and promptly refer them to IGIMS for free medical treatment, in case of any complications,” said Sanjay Kumar Singh, executive director of the State Health Society, Bihar.

A government inquiry report, dated December 2, by a four-member district level committee headed by additional chief medical officer Dr Subhash Singh said that the cataract operations “prima facie” pointed to medical negligence. A subsequent swab culture report on December 3, a copy of which is with HT, isolated the presence of “Gram Negative bacilli (pseudomonas aeruginosa)”, indicating that the outbreak was linked to improper sterilisation of the OT, said a doctor at Muzaffarpur’s Sri Krishna Medical College Hospital (SKMCH), requesting anonymity. Based on the microbiology report, the committee in its final report to the civil surgeon on December 6, gave a clean chit to the operating surgeon and concluded that infected equipment in the operation theatre was the source of infection. HT has a copy of the inquiry report.

The doctor conducting the surgeries, however, also broke protocol with the number of surgeries conducted in a day – as high as 65. “As per the national guideline for doing eye camp surgeries, a doctor should not do more than 25-30 surgeries a day,” said Dr Rajvardhan Azad, former chief, Rajendra Prasad Centre, AIIMS, New Delhi.

The inquiry headed by Dr Harish Chandra Ojha also found that there were no tiles inside the walls of OT, an important prerequisite, and that the hospital did not have any regular doctors on its rolls, and engaged doctors depending on the caseload at the eye camps.

When patients returned with complications in their eyes a couple of days after the cataract surgery, an optometrist examined the patients in the absence of regular doctors, the inquiry report said.

Efforts to reach Tirhut divisional commissioner Mihir Kumar Singh were unsuccessful. While one of his official numbers was switched off, the other number, mentioned on the website of the Muzaffarpur district administration website, said: “Incoming call facility to the dialled number is currently not available.” HT also tried to reach the doctor that conducted the operations, but he was unavailable for comment as well.

Failing health care

It is not without reason that Darzi prefers a private centre for treatment. Just a kilometre away from Darzi’s residence is the additional primary health centre (APHC) at Mahant Maniyari village. The outdoor patient department (OPD) and in-patient department (IPD) facilities there are non-existent. Since the incident, an optometrist from a private hospital comes for around 90 minutes to check the vision of patients once a week.

All APHC has in the name of equipment are two weighing scales — one for adults and another for infants. It has all of 30 medicines, mostly antibiotics, pain killers and paracetamol tablets in its formulary. Despite the posting of three general duty medical officers, Dr Pooja Singh was the lone medical officer present around noon on December 4, when this reporter visited the two-room APHC. What was earlier the operation theatre (OT) of the Mahant Maniyari Darshan Das Hospital, a private health facility, which now houses the government APHC, is a junkyard. The ward where patients were once admitted is now a storehouse of wheat, cattle fodder, and hay.

“The OT existed between 1982 and 1989-90. Doctors of SKMCH used to come to do post-mortem examination and surgery,” said Anand Gaurav, a local resident.

The district hospital in Muzaffarpur, 15km away, is only a shade better. There’s an OPD for eye patients, but no IPD. It’s among 16 of 36 district hospitals in Bihar that does not have an operation theatre for eye surgeries, according to state programme officer for blindness control Dr Ojha.