Rural
Health Care
I
live in Phaltan a taluka town in western Maharashtra and describe
below a personal experience of rural health care in
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
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
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
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
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
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
The
moment we reached the
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 –
In a
corrupt society like
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.
January
2011