Rural Health Care

 

Anil K. Rajvanshi

anilrajvanshi@gmail.com

 

I live in Phaltan a taluka town in western Maharashtra and describe below a personal experience of rural health care in Maharashtra. This is typical in most of the rural areas of India with situation even worse in some poor states like U.P., Bihar, West Bengal etc.

 

On Sunday 26th December 2010 my mother, who is 86 years old, fell down in the house and broke her hip. She realized it soon since she could not “find” her leg.  I immediately called the local orthopedic surgeon and asked for the ambulance. He said that his hospital does not have an ambulance and will give me the phone number where I could ask for it.  He returned the call after an hour or so, but by this time I had got the services of a ramshackle maruti van ambulance.

 

Getting my mother into the stretcher of the van was quite a task since an ambulance van in small rural areas does not come with any paramedics but only the driver. So my daughter Noorie who had come home for a 15 days’ vacation from U.S., myself, the driver and my wife lifted my mother in a thick blanket and put her on the stretcher.

 

We then took her to the local orthopedics hospital which is supposed to be the best in Phaltan.  It is a 10-20 bed hospital (the bed count is dependent on how many of them are kept in the corridors!) The shoddy X-ray at the hospital showed that she had broken her femur and the fracture was complicated and an operation will have to be done to repair the joint. The orthopedics surgeon told me with a bravado that he can do this operation and has been doing these types of operations for the last 20 years! 

 

When I informed the doctor that at 86 and with severe osteoporosis, my mother may need a better X-ray, maybe a digital one so as to decide whether her bones are fit for the operation or a hip replacement, he informed me that from this simple X-ray he can make out the bone density which the digital scan will not show! His supreme knowledge and a know - all attitude was amazing! This is normally the case in all small towns where the doctors think they know everything. This attitude normally comes because of tremendous insecurities of these people.            

 

Besides, the moment the doctor saw the X-ray of my mother he informed me that he will only do the surgery after 5 days! His extremely stupid logic was that because of swelling (which was not very much since it was only few hours after the accident) too much blood will be lost if surgery was done immediately. No amount of reasoning by my brother, who is a senior orthopedic surgeon in Australia, on the phone that an immediate operation is a must since pain removal in aged patients is a priority because of their general condition, would convince him. Thus I had very serious doubts about the competence of the doctor and mind you he kept on insisting that he has been doing such operations for 20 years!

 

Nevertheless he put the splint and traction and gave pain reliever injections to her so that immediate relief was provided.

   

I was continuously thinking of taking my mother to Pune and the last straw was when the doctor  informed  me that there is no nursing care in his hospital and we will have to do everything ourselves ! In essence he informed us that he will just do the operation and the rest is upto us. I came to know later on that nursing care in all rural hospitals and clinics in western Maharashtra is non-existent. The family members provide it. This includes giving bed pans, running around to get medicines and requesting the nurses to administer injections and medicines.       

 

At that point I felt extremely dejected and an over-whelming feeling came over me that I made the biggest mistake of my life by coming to Phaltan from U.S. In my 30 years of stay in Phaltan I never had this feeling but the reality of situation somehow brought this out.  It is not that I did not know about the medical-care situation in Phaltan but a direct experience had a hammer-like impact. I felt that in 30 years, situation in Phaltan has gone from bad to worse. Thirty years’ ago there was hardly any medical facilities available. So the moment an accident occurred the patient was shifted to Pune. Since the roads were O.K. and there was hardly any traffic on them one could reach Pune in a relatively short time. But now because of the so called facilities available in Phaltan a patient is confused as to whether to go to Pune or not and with false promises by doctors (as the orthopedics surgeon gave me) they end up being fleeced by them.     

      

The general cleanliness of the hospital in Phaltan was horrible. There were no bulbs in the simple stark room given to us. I had to go to the ward boy and after an hour’s wait, two bulbs (one for the bathroom and other for the room) were provided.  No bed sheets or pillows were provided.  All these have to be provided by the patients. The bathroom was dirty so that the attendant had a tough time using it. And the room had windows which could not be closed so during the night the cold draught came directly on my mother’s bed since it was next to the window. On the top of all this the decrepit hospital was undergoing renovations and with deafening noises coming from the carpenter’s tools (some renovations was being done in the hospital) the whole scene was a nightmare and somehow the night was passed.

 

The noise and the scene in the hospital reminded me of movie scenes of medieval ages where the patients would be lodged in the ramshackle rooms while the surgeon and doctor worked on the them without any anesthesia which would create a noisy atmosphere in the hospital. The howling sound in the medieval hospital was replaced here by the deafening noise of the carpenters and the construction workers which only ended at 8:30 or 9 p.m.

 

I rang up my friends and they fixed her to be taken to Sancheti Hospital - a well known orthopedic hospital in Pune. However this had to be done the next day. I informed the Phaltan doctor of my decision and his enthusiasm (whatever he had) for my mother simply vanished. In any case my mother had to be kept in the orthopedics clinic for the night. My younger daughter stayed with my mother at night and provided her with all nursing care like providing bed pan etc.    

 

Transporting her from Phaltan hospital to Sancheti in Pune next day was itself a major task. A ramshackle ambulance was procured. In Phaltan there are no proper ambulances available, but only ramshackle Maruti vans with a stretcher fitted in it. The owner/driver looked like a Bollywood villain and with great persuasion he drove at 30-40 km/hr. He kept on telling me that most of the patients he transports to Pune are in coma and hence he goes at 70-80 km/hr, since they cannot sense the rough ride or anything! I am told that these rural ambulances are also used for nefarious activities since with blaring sirens and blue lights flashing they can go through any traffic conditions and also pass the police and other check points easily. The roads between Phaltan and Pune have become like moon scope full of craters and the 100 km journey from Phaltan to Pune was done in 4 hours!

 

Since I was shifting my mother to Pune the attitude of the orthopedics doctor at Phaltan became really strange. He removed the splint which was meant to keep my mother immobilized and I had to tie her hips and legs with a piece of cloth during the journey. This was on the advice of my orthopedic surgeon brother who was in Delhi and had come for a short visit from Australia. He was frantically trying to get the first flight to Pune. The only thing the doctor did (after pleading with him) was to give a pain reliever injection which mercifully lasted till my mother arrived in Pune.

 

The moment we reached the Sancheti Hospital at 1:30 p.m. on 27th December the whole scene changed. Immediately my mother was wheeled into the casualty ward and extensive tests including bone density, her general condition for operation, X-rays, blood testing etc. was done very professionally and at night Dr Sancheti informed us that he will do the operation in the morning himself. Besides they also put a proper splint to keep her hip immobilized.

 

The operation and partial hip replacement, done on 28th December morning, was a success and now my mother after 3 weeks stay in Sancheti Hospital has returned home and is recovering well. For old patients it is extremely important that the pain should be relieved as soon as possible which is done if operation is performed soon-something the Phaltan Doctor did not seem to understand.

   

We found the quality of medicare at Sancheti was of world class standards. This included the quality of surgery, nursing care and post operative care like physiotherapy. My brother himself took part in few surgeries with Dr. Sancheti in their operation room and he described the whole set up as world class. Of course this care does not come cheap, but at least a world class facility is available for patients who can afford it.

     

It is a sad state of affairs that even after 63 years of independence, in a rich and progressive part of Maharashtra – Western Maharashtra, the quality of medical care leaves much to be desired.  It is absolutely pits and very shoddy. The general condition that I have described above is true of all rural hospitals. No nursing care is provided. If complications occur the doctors simply vanish and are not accountable to anybody. Quite a number of times the relatives have rightly beaten up the doctors in these rural hospitals for botching up the cases. It is mostly a money-making racket.

 

In a corrupt society like India large number of educational institutes of higher learning have sprung up in all parts of the country including rural areas. Most of these Institutes, which provide very poor quality of education, are being run by politically connected people, and are nothing else but money making racket. Most of them can get away with murder since the students do not challenge the quality of education or the owners. As a dear friend of mine Abhay Vaidya has rightly pointed out these same people will not set up rural hospitals, since they will be accountable for botched up cases.

   

The rural people are trusting and feel that the doctor is doing a great service to them. Thus they provide all the materials and help including nursing care – something that the hospital should provide.  That is the reason why the presence of whole family is continuously needed for patient care. The attitude of doctors either in big cities or small places is mostly casual and careless and they only care for the money.

 

I do not know how affordable rural health care can be provided, but feel that setting up of nursing Institutes in rural areas will certainly help. Also creative insurance instruments by Govt. of India which allow rural poor to get high quality medical care will help in setting up many first class medical facilities in rural areas.  

 

The human body of both the rich and the poor is same and hence the same medical care should be given to everybody. Affordable medical care for all should be the main plank of the government and unless and until it is achieved India can never join the ranks of great nations and will remain a third world country as it is today.

 

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January 2011