Grief hung heavy in the modest house with its bare floor and unplastered walls. Outside, a few anxious faces looked up as Navami, 20, stepped out, flanked by her ageing grandmother Seethamma. Her father, Vishruthan, sat silently on a chair nearby, eyes brimming.
With a heavy heart, Navami bid a quiet goodbye and walked up the flight of steps leading to the road, where a car waited to take her to the Government Medical College Hospital, Kottayam. She looked back at her house before getting into the waiting vehicle, as memories of her mother refused to leave their home.
Navaneeth and Navami, children of Bindu, grieving in front of their mother’s body.
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VISHNU PRATHAP
Navami, a final-year B.Sc. nursing student is heading in for surgery. And it is her second attempt. The first trip was on July 1 with her mother, D. Bindu, by her side. But that hospital stay was tragically cut short. Just three days later, on the morning of July 3, a dilapidated bathroom block in the hospital collapsed. Bindu, who was the caregiver for her daughter, was trapped under the rubble. It took over two hours to retrieve her body. By then, she was dead.
The tragedy triggered a political firestorm as the building had been deemed unsafe for over a decade. Opposition parties took to the streets pointing out that patients were forced to use it because of a lack of facilities. After the incident, the bulldozer could not reach the spot on time to rescue Bindu; they pointed out, clashing with the police, demanding the resignation of Kerala Health Minister Veena George.
Accusations flew thick and fast, only to be met with equally forceful counterclaims. But in Navami’s home, there was no appetite for blame games. For the family, nothing mattered more than the devastating truth that Bindu was no more.
“They all came. Ministers, party leaders, and the District Collector. They consoled us and gave us assurances. That means something, yes… but we’ve lost her,” says Vishruthan, his voice heavy with sorrow.
Ahead of her return to the hospital, a team of doctors visited Navami to provide counselling. The young woman, who has already been assessed by neurologists and orthopaedics, will go under the knife shortly.
Amidst the outrage and questions over administrative failures, the disturbing question that emerges is what ails the State’s famed Kerala model of health care. Questions are being asked with renewed vigour about patient safety, quality of health-care, ageing infrastructure, and shortage of manpower in government medical college hospitals (MCH) across the State.
Public health experts fear that underinvestment in the infrastructure sector and human resources is finally taking its toll. A recent social media post of Haris Chirackal, Head of the Department of Urology of Thiruvananthapuram Medical College Hospital, on the shortage of facilities at the hospital and the resultant sufferings of patients had grabbed the headlines.
Health Minister Veena George consoles the family of Bindu, who died in the building collapses at the Medical College Hospital, Kottayam.
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VISHNU PRATHAP
His post, raw with helplessness, struck a nerve with his colleagues across the State. The hospital, Kerala’s first MCH, has grown well beyond its present infrastructural and human resources availability. Departments expand, new equipment is added yearly, but the staff strength remains frozen in time.
“It is ridiculous that the cumbersome and outdated procedures for equipment maintenance and purchase that are generally applied to all government departments are brought to bear on the MCHs too, because these are hospitals which run round the clock, handling a huge patient load. For the purchase of any accessory above ₹1 lakh, the file has to be cleared by the District Collector, who heads the hospital development society (HDS). Red tapism is slowing the process and a department head will often have to spend a lot of time pursuing a file through various administrative sections to ensure that it reaches its destination for clearance,” confides one of the department heads at Thiruvananthapuram MCH.
“Instead of going on a spree of constructions and purchase of fancy equipment, the government should focus on the timely maintenance of existing buildings, equipment, and facilities properly to improve the quality of health-care,” he adds.
Rosenara Beegum, Professor of Nuclear Medicine and president of the Kerala Government Medical College Teachers’ Association, points out that health-care today is a resource-intensive and technology-driven one. “But the government invests only in infrastructure and not in people. What good is a catheterisation laboratory (a specialised medical facility equipped with advanced imaging and monitoring technology) without anyone to run it round the clock?”
Departments such as Gynaecology, Orthopaedics, and Surgery, with high patient load, haven’t seen post creation in years. Frequent transfers prevent doctors from investing in departments long term and bureaucratic hurdles make even basic maintenance a nightmare, she points out.
Excavator machines clearing rubble of the collapsed building at the Government Medical College Hospital, Kottayam.
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VISHNU PRATHAP
Even the stopgap funding options are drying up. The hospital development societies are now cash-starved thanks to delayed reimbursements from the Karunya Arogya Suraksha Padhati (KASP), the State’s flagship health insurance scheme. The government owes public hospitals a whopping ₹1,203.59 crore as KASP reimbursement, say public health experts.
The only source of income for the hospital development societies is the meagre user fee collected for some procedures or CT and MRI scans from the paying category of patients.
“Hospitals cannot run on government funds alone anymore. We need functional autonomy and self-sustaining models,” says K.V. Vishwanathan, Director of Medical Education in-charge.
“Funds are never sufficient because people loath to pay any kind of user fee. A recent proposal to introduce an outpatient ticket fee of ₹10 was greeted with stiff resistance. The HDS has to find funds for waste management and annual maintenance contracts,” he points out.
“We can’t turn anyone away,” Dr. Vishwanathan adds. “Unless secondary hospitals are strengthened, medical colleges will keep overflowing.”
The manpower crunch has hit the Alappuzha MCH hard. The posts of 80 Assistant Professors, 10 Associate Professors, and two Professors are lying vacant, including those on leave. This is one MCH in the State without a payward.
U.M. Kabeer, a member of HDS, says that patients have to wait up to six months for heart surgeries. Immediate steps should be taken to fill the vacant posts of doctors, he says.
“Over 1,500 patients undergo medical treatment daily as inpatients, which is more than the bed-strength of 1,050 of the hospital. The construction of the payward is under way. We hope to fill the vacancies soon,” says a hospital administrator.
The story is much the same in the Kozhikode MCH. Serving five northern districts of Kerala, the hospital handles 2,000 to 3,000 people in its outpatient department a day. But staffing levels remain stuck in the 1960s. Distributors of drugs and surgical devices stopped their supplies due to non-payment of bills at least twice in the past two years. Even though the supplies were resumed, the dues have not been completely cleared.
At the Kottayam MCH, however, the immediate concern is the future of the old buildings. Will they be retained or razed down? A safety audit by the Public Works department is under way to determine the answer.
Official sources hold that the existing block, which collapsed, was constructed way back in 1964. “The existing building safety rules stipulate a sufficient pathway to bring in rescue machinery around the structure. Without a passage, an earthmover could not be brought in time to begin the rescue mission,” admits a top official.
With an ever-increasing number of patients, ageing infrastructure and paucity of funds and manpower shortage, the flagship public health institutions of the State are showing signs of severe stress. Experts suggest measures like administrative revamp, updating purchase rules, financial autonomy to institutional heads, and investment in human resources to resuscitate the system.
Jose Chathukulam, a public health expert and Director, Centre for Rural Management, Kottayam, notes that the MCHs are grappled by an efficiency crisis, riddled with restrictive practices and guarded by an iron shield of public affection.
“Even while the post of the Principal and the superintendent goes to the seniors, they should be supported by a professional team of administrators. Kerala shall raise funds to invest in infrastructure, health administration, and human resources in the health sector,” he suggests.
Minister’s stance
Veena George, Minister for Health, says the medical colleges together received over ₹3,500 crore during the last five years for improving the infrastructure. “The period also witnessed upgradation of treatment facilities, introduction of modern equipment, quality improvement in medical education, and opening of super-specialty blocks and departments in various colleges. The MCHs are poised for a huge leap in terms of quality and high-end treatment. We are constantly striving to cater to the ever-increasing needs of people, who are depending on the hospitals,” she says.
“If the annual OP registration in government hospitals, including the MCHs, was eight crore in 2015, it’s now 13.5 crore, which alone shows the trust the people have reposed in the MCHs. Though the MCHs are considered referral hospitals, a situation has emerged where any patient can walk in and get the required medical treatment. All the MCHs are handling patients three to four times their bed capacity. This has led to an unpleasant situation where people are forced to occupy every available space in the hospitals. The dependence of people on the public health system has also led to a situation where private hospitals are forced to slash their treatment costs,” says Ms. Veena.
“We are at present handling a larger number of patients than the existing capacity of all the MCHs taken together. It is adding a huge load on the system. All the major medical colleges across the State saw development projects being implemented during the past few years. Dearth of funds is no longer an issue for the healthcare sector. The government is pooling resources from all possible sources to step up the quality of health-care,” she asserts.
The solatium announced by the government may bring some relief to Navami, who lost her mother in the accident. Thousands of patients such as Navami are looking up to the government and the medical college hospitals to regain health and bounce back to life.
