Taluk GHs, lifeline of rural areas, lie in comatose state
In a broad perspective everything appears great, but the reality is far from the claims made by the government and COVID19 exposed the shortcomings as there is an acute shortage of doctors and paramedical staff; sanctioned strength of doctors in the yea
For people like M. Singaperumal, 60, of Tirumangalam, who pulls cart for a living, going to a private hospital or clinic if he falls sick is out of the question. Daily wagers like him just cannot afford the high fees and prescribed medicines.
“Even to buy a fever tablet, I travel all the way from my village to Tirumangalam Government Hospital. With the ₹300 I earn in a day, I have to manage my family’s health expenses and buy groceries, too,” he says.
“But if I had money, I will certainly go a private hospital. Because I have to waste a whole day waiting at the GH to see the doctor,” he says.
A National Sample Survey Office survey in 2015 revealed that about more than half of India’s rural population uses private healthcare, which is four times costlier than public healthcare, and can cost the poorest 20% of Indians more than 15 times their average monthly expenditure.
Another of its recent survey revealed that 48% of overnight trips made by millions of Indians from rural areas (25% in urban areas) are for medical purposes.
Pointing to the survey, a government taluk hospital Chief Medical Officer (CMO) says all these journeys people make reflects the failure of publichealth system in the world’s fastest growing economy.
While treatment for fever and minor ailments are available at the local Primary Health Centres (PHCs), major diagnosis or surgeries can be done only at headquarters hospitals, he adds.
Madurai district has seven government hospitals in the outskirts of the district which fall under the Department of Medical and Rural Health Services. Among the nine – Usilampatti, Tirumangalam, Melur, Tirupparankundram, Vadipatti, Peraiyur, Sholavandan Usilampatti is a headquarters hospital.
As taluklevel government hospitals are the upgraded versions of the PHC and Community Health Centres (CHC), medical facilities such as Comprehensive Emergency Obstetric and Newborn Care (CEmONC), Tamil Nadu Accident and Emergency Care Initiative (TAEI) and scanning facilities are available only at taluk hospitals.
The CMO, speaking about the topnotch facilities available at the hospitals, says that in a broad perspective everything will appear great. But the reality is far from the claims made by the government. “COVID19 exposed the shortcomings. There was an acute shortage of doctors and paramedical staff,” he says.
The sanctioned strength of doctors in the year 2000, when the taluk hospitals started emerging, was 25 and the saddest part is that even after 24 years, the sanctioned posts remain the same.
Another senior doctor working in one of the taluk hospitals says, “Facilities like CEmONC and TAEI which were later upgraded in rural hospitals are not given separate doctors,” he says.
On an average, the seven taluk hospitals receive a total of 800 outpatients in a day and in some major hospitals like Tirumangalam, Melur and Usilampatti, it is 1,200. After appointing the 25 doctors, the government has not cared to augment the manpower to handle additional facilities like CEmONC and TAEI, the doctor adds.
Of the 25 sanctioned doctors, five are Chief Civil Surgeons (CCS). In their administrative capacity, they will oversee the working of the hospital, blood bank and head department like obstetrics, gynaecology and paediatrics. Further, 10 doctors 4 obstetrics and gynaecologists, 4 paediatricians and 2 anaesthetists will be overseeing CEmONC department, and the remaining three doctors will be overseeing dental, siddha and yoga wings, the doctor says.
“Out of the remaining seven doctors, two will be on shift basis. So, the 1,200 outpatients must be managed by a mere five doctors,” he adds.
Apart from this, the five doctors must check on the inpatients. Due to situations like this, some of the major surgeries that should be performed in the taluk GH get delayed or are referred to Government Rajaji Hospital in Madurai. Further, hospitals in Vadipatti, Tirumangalam and Melur must treat so many accident cases as they are situated right on busy highways. But these hospitals neither have CT scan or MRI machines. “They should be ideally earmarked as critical hospitals and provided with TAEI for emergency care and a CT scan centre with sufficient radiologists,” he says.
“Many a times when major accidents involving buses occur in the nearby highways, patients cannot be treated here. They had to be rushed to either Usilampatti GH or GRH which are 20km and 29km away, respectively,” says a doctor at Tirumangalam GH. Emphasising the need for CT scans in such hospitals, he says that when critical patients are to be shifted to hospitals in faraway places, they will lose their golden hour resulting in death.
A senior health official, stressing the need for 24hour radiologists in GHs, says most of the accidents occur after dusk. On the absence of a radiologist, the crucial job to identify clots and internal injuries gets missed. Due to this, the patient must be shifted to a nearby hospital, either private or government,” he says. For other major health issues like stroke, when the blood clot is identified and removed within two hours, recent studies have proved that the patient could be cured completely, he adds.
“But when a radiologist or CT scan facility is not present in a hospital, the patients would be forced to visit the private hospital where they’d by paying way beyond their means,” the doctor says.
Moreover, the government is yet to install an MRI machine as per the High Court order dated January 2017 directing that all the 46 headquarters hospitals in the State must have MRI machine.
“Considering this as a poor health indicator, the government should increase spending in the health sector. But machines alone will not improve the standard of treatment, it must be matched with trained manpower,” says the doctor.
A Maduraibased health rights activist A. Veronica Mary, says the most important area of the government in the health sector is to increase the number of sanctioned posts of doctors in tune with the present needs.
Overburdened doctors can never meet the growing requirements. “Increasing the number of nurses, conservancy workers and paramedical staff is also equally important to maintain the hygiene of the hospital,” she says.