Thursday, October 15, 2009

Goa’s Public Hospitals in a Mess

FREDDY DIAS turns the spotlight on the numerous problems and deficiencies in Goa’s government hospitals

It is an oft-heard complaint in government hospitals in Goa that while the actual medical treatment is of good quality, it is the other allied services that upset the patients and leave them with a feeling that they should never have gone to such a place. In fact, a cursory survey among patients in major government hospitals (GMC, Bambolim, Asilo, Mapusa, and Hospicio, Margao) throws up a telling statistic – more than 40 per cent of in-patients had approached private doctors before coming to the government hospitals.

No one actually wants to go to a public hospital. If they are there, it is because they had no other choice. Such is the credibility of public hospitals in Goa today that the middle class avoids them entirely. What were once the leading hospitals in the state, and perhaps in the country, have seen a gradual decline, which has been created by the government’s indifference towards public health in the last few decades.

In the 60s or, for that matter, even earlier, during Portuguese rule, when a new patient was admitted in a public hospital, he or she could be sure to find clean sheets, pillow cases and towels on the bed. But today a patient entering a ward is greeted with filthy sheets, soiled pillowcases and no towels. Drug shortages were unheard of then. In sharp contrast, there is a constant shortage of drugs today, and in fact certain essential medicines are not available in public hospitals for several months.

Enquiries at GMC Hospital revealed that stretchers and wheelchair oxygen supplies were available in the ratio of one for ten patients, while half the patients make do without bedpans, urine pots and spittoons. There is a constant scarcity of water supply at the hospital and, as a result, various wards and particularly the toilets are often found to be in filthy and unhygienic condition. A recent report of the Ad Hoc Committee on Health said that it was totally disheartening to see the poor standards of cleanliness in the GMC hospital and called for a thorough review of the performance of various agencies entrusted with the task of cleanliness. “Mere outsourcing of sweeping and swabbing operations to private agencies will not ensure the best standards of cleanliness expected within the premises of the GMC hospital,” the report says.

The GMC hospital, as is the case at all the other government hospitals, has been facing irregular water supply. The scarcity of water is more acute in the hospital laboratories where running water in the taps is very much required for washing test tubes and sterilising medical instruments. As a result, some of the emergency tests pertaining to patients in the Intensive Care Units (ICUs) are delayed.

Many doctors are also being drawn from government to private hospitals, whose lucrative offers are difficult to resist. The situation will only get worse, with private hospitals coming up everywhere and they are certain to poach the staff at government hospitals, which provide the best training ground for doctors but whose working conditions provide no incentive to stay on.

In fact, as informed to the State Legislative Assembly in response to an unstarred question during the last session of the house, twenty posts of doctors were vacant in various departments of the GMC Hospital. Important departments such as general surgery, orthopaedic, medicine, neuroeurgery do not have adequate number of doctors, while existing staff is compelled to shoulder additional responsibilities.

The Department of Neurosurgery handles 7-10 emergency cases every day and has to perform about 500 operations a year, but it has only three senior consultants, two full-time and one appointed on contract. Similarly, the Orthopaedic Department, which has to handle emergency accident cases besides its regular quota of oethopaedic cases, currently has two posts vacant. According to a senior doctor of the hospital, it is difficult to fill up the vacancies because the pay scale of the government is unattractive in relation to what is offered in the private sector.

Hospital heads blame deteriorating services on sheer numbers. The GMC Hospital alone treats around 7-8 lakh patients in its OPD annually, as patients often bypass peripheral services to come straight to the hospital. GMC Hospital doctors say that 60 per cent of the load in the OPD is due to simple fever and diarrhoea, largely caused by poor living conditions. This would decrease if drinking water and sanitation were improved in the state and then there would be enough resources left in the hospital to treat real illnesses. According to government doctors, overloading is the primary problem in in-patient care, which has led to sharing of beds by patients and putting mattresses on the corridors outside the wards.

The real problem, however, is lack of adequate funding. While the allocation for health has increased considerably over the decades, it is not enough, as in real terms the funds have decreased because it has not accounted adequately for inflation. As a percentage of the total government budget, health has actually dipped from about 36 per cent in the 60s to 28 per cent at present. Of this, 70-75 per cent is spent on salaries of the staff. Moreover, doctors say that while it is not so difficult to buy equipment, it is more difficult to get the necessary funds to maintain it or for other consumables like medicines, gloves, linen, etc. Even when supplies arrive, there is no guarantee that they will reach the patient. For example, while more then seven bedsheets per patient were supplied to the hospital, the number actually available was three, while with towels, two per patient were supplied but none made available.

An official of the Health Department, however, says this will change now, as there has been a decision to allow the hospital heads to directly place orders for one-off purchases of medical supplies and other allied necessities, instead of going through the usual long-drawn procedure. And even while the government official claimed that many of the patients are well off, doctors say that the patients profile is primarily poor, and that 80 per cent of the patients who come to public hospitals are the poorest of the poor, who include migrant labourers and slum dwellers. They simply cannot afford to pay for medical services.

One of the main reasons why people, particularly Goans, are reluctant to approach a public hospital for their health care is the rude behaviour of doctors and nurses. It is mostly the young resident doctors and senior nurses who are rough in their behaviour and language. The Ad Hoc Committee on Health has expressed total dissatisfaction with the attitude of staff at the GMC hospital while dealing with patients and public in general. The Committee feels that the staff who are in direct contact with patients and public should be reoriented in demands of ethics and hospitality services on monthly basis. The Committee also suggested that a scheme of incentives may be instituted for best behaved hospital staff to encourage them to be hospitable towards patients. The effect of the Committee’s report on the government, however, remains to be seen.

Herald October 15 2009 Panaji

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