Government Hospitals in India—A sorry state of Affairs.
Five years ago I read the news doing rounds that a patient that underwent tubectomy at a south India’s government hospital died of complications. It later was learnt that it was a case of Human Error. While the court gave its verdict in this and many other such cases and I would not choose to comment on any verdict or ruling, what remains juxtaposed over so many years is the extremely poor rather neglected conditions in the government hospitals.
While currently there as been some kind of a drive in the nation to expose various scams, whether they be in realty or telecom, we tend to treat hospital experiences as each to his own. In the post independence era about 40 yrs ago the infant and the maternal mortality rate was high and looked ever increasing. While the private healthcare practice has flourished to a large extent in the metros, the healthcare available to the masses yet remains the same. With the costs of treatments and drugs having skyrocketed the mortality indicators remains the same.
All fingers currently get pointed to the recent incident of 14 deaths in the labor ward/ OT of a government hospital at Jodhpur. While the investigations as always will take their own course and the legal machinery burn the midnight oil, what appears to be getting lost are the larger perspective and the real issues that threaten the building of a healthy nation and our staring in the face of the various awareness campaigns led by the ministry of health and Family welfare. It is a clear indication that the current functioning of most of the government and public hospitals is not up to the expectation especially availability, technology and quality.
Until now the investigation and the hospital committee has been stating the contaminated IV fluid as the cause of deaths. Maybe or maybe not still remains undecided.
Dr. Arun Agarwal, a renowned oncology surgeon of the country, who has gathered experience through his practice of the last 27 yrs, including the prestigious Tata Memorial hospital, Mumbai is disturbed at the prevailing situations and strongly states that in his long work experience he has never faced any situation where post operative deaths may have occurred due to administration of IV fluids as is being pointed out in the case at the Jodhpur hospital. IV fluids are a purchase of the hospital and not of any particular ward. Nevertheless, to understand what may be the cause of such deaths, we need to assess the current hygiene conditions in Government hospitals across the country. The problem lies when all investigations are looking towards a temporary situation and not the long term fixation.
Hygiene and Sanitization can be categorized into several levels at any hospital. It begins with personal hygiene of OT staff to Hygiene audits of equipment and the various wards. Unfortunately it is the most neglected at all stages and can result in extreme situations of infections and culminate into deaths. The septic conditions of hospitals in villages is unaccounted for, it is intentionally neglected in the city government hospitals.
Dr. Arun points out that lack of Trained OT staff is one of the key aspects that leads to negligence as understanding and thereby turnaround time to serious situations gets reduced. There is commonly seen a lack of technological advanced equipments and knowledge of its usage. As per regulatory bodies and the norms laid down by the Government itself the sterilization of the wards and Operation theatres is a stringent process. It calls for hospital audits at regular intervals. Audits are not a reference to accounts here, instead it implies to swab cultures that may be retained form various facilities to rule out hospital ward functions. One can refer to the Indian public Health Standards report commissioned by the Ministry of Health and Family welfare. “
Drugs are essential for all acute conditions and emergencies. But if they are resulting in an infection, it results in drug induced side-effects – which are can get dangerous and can be handled if the response time is quick not as slow as waiting for 14 deaths to happen.
Another renowned gynecologist of the country Dr. Shailja Tyagi strongly refutes that the 14 deaths being reported could have been due to contaminated IV fluids. It’s hard to believe she says, especially when we all know and can see the failing conditions at all fronts in our government hospitals. The staff lacks the human touch that is required in the profession and therefore lacks accountability of indentifying the real problem or causes. IV Fluid contamination results in shivers, high grade fever which can be controlled with counter drug management. It rarely or never results in deaths.
A maternity ward is considered as one of the most vulnerable wards and can be prone to infections from the slightest negligence in equipment or the beds and the staff handling the patients. In her work experience abroad she observes that while hospital audits are an inbuilt phenomenon in the healthcare practice globally, in India they are an absolutely ignored space. An obvious why in a situation like so many as above we seek vendors and suppliers as soft targets rather than identify the real causes. While there may be a committee investigating it is important that they focus on the hygiene factors in the labor ward. An absence of a centralized sanitization system for equipments, the right levels of research pathology labs may be causes that led to the situation.
Whatever may have been the reason for the deaths what clearly stands are the safety hazards and the hygiene in government is highly overlooked. It’s time the investigations direct towards the larger issues. We need to think beyond the blame game and take responsibility of the systems we set up and rules we define for ourselves. Perhaps the most important factor that will change the sorry state of the public medical system is pressure from the public. It would be wonderful, however, if doctors were a part of the move for change.
Anil Sharma
098260 42215
