What ails healthcare in India?

Two incidents in November raise very serious questions about the state of healthcare in India: the botched up sterilisation drive in Bilaspur, Chhattisgarh and the mishap involving an MRI machine at Tata Memorial Hospital’s (TMH) Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) in Kharghar, Navi Mumbai

201412ehm02Two incidents in November raise very serious questions about the state of healthcare in India: the botched up sterilisation drive in Bilaspur, Chhattisgarh and the mishap involving an MRI machine at Tata Memorial Hospital’s (TMH) Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) in Kharghar, Navi Mumbai.

The Bilaspur incident, in early November, resulted in the deaths of at least 14 young mothers. Investigations later revealed that both the medical staff as well as the medicines used were at fault.

In the haste to achieve targets, the doctor concerned reportedly conducted 83 operations in five hours. Disregarding all medical practice guidelines, he reportedly used just one instrument for all operations. And to top things off, the drugs used were later found to be laced with rat poison. The doctor concerned cited his past record as evidence of his expertise: he had received an award for conducting 50,000 laparoscopic tubectomies from the Chief Minister. And the owner of the company which made the drug turned out to have close political connections. There are many blind spots in rural India; Bilaspur is the rule and not the exception.

But it seems that all the bad press and inquiries into the Bilaspur tragedy were in vain. On November 30, there were reports that a doctor had used bicycle pumps to pump air into the abdomen of women during the course of laparoscopic tubectomies at yet another sterilisation camp, again organised by government authorities at yet another rural outpost, this time in Banarpal village, about 150 km from Bhubaneswar. This doctor, who like his peer in Bilaspur is also the recipient of government awards for his past enthusiasm towards this cause, said this was a routine practice and was an example of India’s famed ‘jugaad’ innovation to cope with the lack of funds for proper equipment. According to him, he sterilised the pipe and nozzle tip of the pump before use, which to his mind was adequate due diligence.

In the ACTREC incident, there are conflicting reports of what actually happened. The facts are that an MRI machine’s magnetic field sucked an oxygen cylinder, trapping a ward boy and technician against the machine for four hours, resulting in severe damage to the latter’s kidneys. Preliminary investigations as part of a larger inquiry by TMH point to the possibility that the switch to deactivate the magnetic field had either malfunctioned or had been disabled by the medical equipment company concerned, ironically to prevent accidental operation by patients. Unfortunately, the ACTREC facility is on the outskirts of Navi Mumbai, hence it was a good four hours before the maintenance staff could respond to ACTREC’s call and release the two ACTREC staff. The report of the medical equipment company’s own parallel investigation is expected in early December and should throw more light on what actually went wrong? Was it a freak mishap? Did the machine malfunction and if so, was it a maintenance issue or something else? Or was it human error, due to ignorance or worse, negligence? If both parties can learn from the incident, rectify systemic errors if any, as well as strengthen staff training and patient awareness, and be transparent about these remedial measures, it will go a long way towards putting patient care back at the centre of healthcare.

On one hand, we applaud our Government’s move to grant visas on arrival, which will encourage medical tourists coming to India. But on the other hand, certain pockets of India continue to exist in a different era. That India’s public healthcare system is non-existent is not news. But the widening and glaring gap between public and private healthcare is nothing short of a national shame. Sprucing up public healthcare is not about cosmetic gestures like an exterior paint job or dressing up the OPD and waiting areas. It is not an overnight process nor is it only about the money. It is about committing time, money and resources over the long term. As our cover story in the December Hospital Infrastructure special issue shows, quite a few of Mumbai’s public/ charitable hospitals, some of them over a century old, have been or are in the process of being revamped. A sign that when the heart is willing, the head finds a way.

PM Modi’s push for a universal health insurance scheme seems like a distant dream for the families who lost their daughters and daughters-in-law and the children who lost their mothers in Bilaspur and elsewhere. Until we find a way to marry the technical expertise and technology of private healthcare with the access and affordability of the public healthcare system, achhe din will not be a universal dream.

Viveka Roychowdhury
Editor

viveka.r@expressindia.com

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