Wednesday, January 30, 2008

Accountability in GH - 4 (Enquiry at the Gosha hospital)

We had previously filed a corruption complaint in GOSHA hospital and it came for enquiry yesterday(30th Jan). So Prabha, Bharathi (the person who had to pay bribes, while her cousin was admitted for delivery) and I went to the GOSHA hospital just on time. We were made to sit for about half an hour. Then the director came out and started gathering all the staff. We thought it was for the enquiry. Only later we realised that she was collecting all the staff to remembering Gandhi (since it was his death anniversary) by observing one minute's silence, followed by a resolution, to uphold principles, be a good citizen etc etc. The irony for us need hardly be mentioned.

Then we waited for a little more time. We were called into the RMO's office. When we filed our complaint, we had complained about watchmen, female attenders and sweepers. We had also given the date and the rough time when Bharathi had to pay money. All the female attenders who were on the duty at the time we had mentioned were called one by one inside and we were asked to identify the cuplrits. Bharathi said no to the first person. Then a second lady walked in. Bharathi said that this lady was among the group which had demanded money, though she was not the one who verbally asked for it. The RMO also told us that he was not the one who was supposed to conduct the enquiry but it was somebody else, and on that day morning, this RMO was handed over the job of conducting the enquiry. He told us that this was the reason, why he had not got everybody ready. He called up another person and ordered him to get all the watchmen to our room. Then the RMO just called all the ladies inside. Bharathi identified one more lady. She was the one who demanded money saying "Kudu ma, mutha kuzhanthai thaane, athuvum aan kozhanthai, kudu. 300 ruba kudu" (Give! This is the first child right and that too a male child. Give 300 rupees). They had refused to let the mother's mother in law in unless 300 rupees was given. So we identified this lady. The RMO was also very impatient. He kept telling Bharathi that she should identify people clearly and that she should tell events clearly. People who are not confident when they complain will feel threatened when subjected to the way the RMO talked. But by and large, he was ok. He clearly saw that money was taken and was helping us identify people. After we identified this lady, she tried to get away by saying things like "Look at my face and tell me. Did I ask you for money??" and all that. But the RMO was very strict with her asking her not to do such things. The nurse superintendent who was also there, tried to find holes in our evidence saying things like "how could you know?" and also things like since the patient's mother-in-law was the attender, she should come for the enquiry.

The RMO also asked us why we waited for so long to file a complaint (we filed it one month after the delivery) and also why Bharathi had not called up the number that was put up on boards in many places in the hospital as the one to be contacted if anybody asks for a bribe). We tried to explain to him that no patient (or their attenders) would call up and complain while the patient is still in the hospital. I also told him, that I had written to the Vigilance (DVAC) about it and only later complained to the hospital.

At the end of the enquiry we could still not identify the lady who took the 300 from Bharathi saying that only then they will be allowed to see the baby. Neither could we get a chance to identify the watchmen or the sweepers. But the RMO decided that we end the enquiry for that day and continue it on some other day, when they will be better prepared for the enquiry. Then we met the director and then came away. The second part might happen sometime next week.

But if anybody is wondering why file a complaint at all, there are two reasons. One, is just to do the right thing. The other is to know the system and also somehow get in touch with the hospital authorities and try finding a solution to the problem.

Saturday, January 26, 2008

Accountability in GH - 3 (The HOD agrees)

There is some wonderful news on this front. We tried to meet the HOD of the Cardio Thoracic block twice this week. We succeeded only the second time. We told him that we were social workers and were interested in implementing a system where in patients are registered and are sent back home, after giving a registration number and a tentative date of surgery. This can be updated to them over phone or through a letter. There will also be a phone number on which patients call up and check their status. He said how this will not work since there are a lot of people coming with recommendation. He showed us how he has got letters from politicians. He specifically told me of an ex Health Minister himself giving a recommendation letter. he showed me a bunch of 10-15 such letters. He said these are the issues, and if he does not listen to them, then he will be transferred as a punishment. Then we told him, that we will accommodate even recommendations, but still bringing in a token system will be of wonderful use to the patients. We told him that we will bear all the costs of putting up such a system and later transfer the system to the hospital after 1 or 2 years. He seemed convinced and called in two of his colleagues in the same department to discuss the idea.

They were Dr. Raja venkatesh and Dr.Venkatachalam. They gave me suggestions like doing some other kind of work. Dr.Harshavardhan said we can help in writing Drug slips for out patients or help in keying in case histories. We were not at all interested. We told them clearly that we intend to work only on the waiting time issue, though once some sort of solution comes up for that, we might consider doing other things also. But Dr.Harshavardhan spoke well through out. Since we said we will take up all the costs, he said that he did not have any objection if we want to implement it. And that he will co-operate with us. He said, he also was keen on doing something different and better than other units, and he wanted this unit to be a model. The only thing he said was that we need to get permission from the dean of the college, and hence asked us to come with a letter addressed to the Dean through the HOD, CT block. We are preparing that note and some kind of time line for implementing the system. We hope the dean agrees. But that we have got the consent of the HOD is a very important step forward. And once the dean also agrees, that IS something :-)

RTI Project Updates - 8

This week we were able to spread the word about the helplines better. There was a mention about the helplines in Radio Mirchi, thanks to an interview with Lokesh, through which there were five callers on a single day. There was a small goof up here. Radio Mirchi did not announce that people have to call between 1 and 2 in the afternoon, and hence people kept calling at all the times :-). There was box item in a magazine called "Puthiya Parvai" (Scan below). Hence there were about 10 phone calls on the helpline this week.

Awareness sessions
The awareness sessions scheduled for this week were postponed. But I have fixed two awareness sessions this week in 2 villages. One will happen on feb 5th in Sivagangai district in Thiruppachetti village. The other one is in Banavaram in Vellore district, though the date is not fixed. Yesterday I was called for a discussion by CSIM (Centre of Social Initiative and Management) who run courses on Social entrepreneurship. There will be an awareness session on Monday in Taramani (the one that was scheduled for last week).

Other material
The RTI publicity cards (in the size of visiting cards) were printed and are ready now. Will distribute them to as many people as possible. A banner has been readied for use in awareness sessions. I am also preparing a brief write up on RTI which I intend to distribute when I do awareness sessions among people who can read and write. This will contain four sides, two of which will contain key points of the act. One side will contain a flowchart which will explain the procedure of filing and appeal processes, and the final side will contain a sample application.

This week I went to the commission twice. Once Mr.Dhandapani was on leave, and the second time I went to meet him, he said he wanted 2 or 3 more days, to give me the copies since he had to discuss the thing with the commissioners. I pointed out that the commissioner has already said ok, but in reoply to that, he talked of some other issues like how some PIOs have replied to their orders and how they intend to act on it. He was not logical at all, but I decided to wait. He asked me to come back on Friday. Next week, if I dont get the copies I will talk to the commissioner and complain to him about the Registrar.

Sunday, January 20, 2008

Accountability in GH - 2

We spent a considerable time in these two weeks trying to talk to officials in government hospitals.

As mentioned in "Accountability in GH" We were trying to meet the Head of the Cardio Thoracic block in GH. So we went one day, but his room was locked. When we enquired around we were told that the Chief had come, but might be on rounds, and asked us to wait. We thought, that while we were waiting, we can go to the ward where Manjula was admitted and see if we can talk to some people. There we saw a girl, Satya, who had been admitted before Manjula. We remember her and she too remembered us. On asking, we learnt that her name was Satya. Satya is a very active girl who is always ready to help others with her "experience" in the ward. She had finished here 10th standard education in April 2007. But then was admitted here in June. But she had not yet been operated upon. She had been to the operation theatre and back 12 times. (A useful thing to do when reading such numbers is to count till the given number in mind, and each time think of the activity. Say, 1, Go to the OT and come back, 2, go to the OT and come back, 3 go to the OT and so on. That will give a good idea of what the writer is trying to convey) She could not continue her 11th std education since she was admitted here in GH. Half of this academic year is over. And still her surgery has not happened. One year of her life is wasted. Thanks to a lack of any time allocation system in this hospital. Meanwhile there was a call for Prabha that she had to meet a school principal. So we could not wait any longer and hence went back without meeting him. We came back again on another day (last monday 14th Jan). But he was on leave and, that he will not be back till Saturday. Hence we could not meet him at all.

Some time back we had filed a complain with DVAC against corruption in a government hospital, which was mentioned in this post. We also wanted to look at the accountability mechanism within the hospital rather than outside. So We thought that we can directly go to the hospital and file a complaint and see what will come out of it. So Prabha, Bharathi and I went there, and met the RMO (by now, we have been to government hospitals enough times to know that every hospital has an RMO, who kind of takes care of administration in the hospital). He asked us to give the complaint with more details of date and time when the incidents happened. He asked us to meet the Director of the hospital too. She was Dr.Vasantha M Subbiah. As soon as she saw the complaint, she asked us why we waited so long to file a complaint. She also asked us why Bharathi did not complain as soon as the people there asked her for money. We pointed out that since the mother and child are still in the hospital, we would naturally be apprehensive in refusing the money that was. She didnt consider that a good reason for giving bribes and said that the staff there cant lay their hands on the mother or child and that we should not hesitate to complain.

She pointed out how she had put up boards everywhere in the hospital that giving and taking money is a crime and that if there were any such instances a complaint can be lodged at the given phone number. She also told us how several attempts at curbing corruption have not helped. She had tried, suspension, fines and she said that nothing worked, since the amount they are fined is much less than what they earn as bribes. Her opinion was that only police action will dissuade the staff from taking bribes. Once one or two employess were arrested by the police, then others might be wary. She anyway took our complaint, and said that she will call us when she is conducting the enquiry. Overall, she seemed to be a sincere person. And we had hopes of working with her in the future.

Coming back from the hospital, we were wondering about a solution to the corruption problem in hospitals. One possibility is that we can put a person in the hospital (if the director agrees) and ask that person to talk to every patient who is getting discharged, and then take the complaints. This will be a proactive way since patients on their own, at the time of discharge from the hospital, would only be relieved that the ordeal has ended and wouldnt bother to come and complain. Hence having a person at the time of discharge ask them about any problems they faced, might just push them to make complaints. But still, we are wondering what process would set the system right, so that an interference from our side is not necessary in every government hospital to keep corruption out. We are thinking on that since, once we feel that have a good idea we can talk to the director and try the idea in that hospital. Suggestions are welcome. (Leave your suggestions as a comment)

RTI Project Updates 6,7

This update is for the 6th and 7th weeks combined. I just couldnt do it last week and hence am combining it.

Awareness sessions
At our last awareness session, we had a problem of gathering people. This could have been solved in two ways.
1. Either get a street play team which will enact a play thereby attracting crowds.
2. Conduct the awareness session through an organisation which will do the part of bringing people together.

I am trying to get a team ready to do the street play. Or at least prepare a video of a street play. And then play it wherever necessary. But meanwhile I am also talking to organisations which can help us organise awareness sessions. One such group is AIDWA (All India Democratic Women's Association). Through them I am planning to conduct an RTI awareness session tomorrow at 2 PM in a slum in Taramani.

BTW, I have also been talking to other groups and individuals and another RTI awareness session MIGHT happen this saturday in a slum in Ashok Nagar.

Information Commission
I will meet Mr.Dhandapani tomorrow (since 22nd is the date he had asked me to come), and tomorrow I will definitely find a way to get the copies of the decisions. Let me see how it goes.

Helplines Awareness
The cards (which I said would be ready about a fortnight back have gone for printing today. They will definitely be ready tomorrow. I am printing about 3000 of them as the first lot. Once they are ready I will give them out for distribution. I am also looking at the media and as mentioned before, a magazine called Puthiya Parvai is already available in the stores, which has information about this helpline (I will send out a scan soon). Srininvasan, a friend here in AID India promised that he will get me in touch with other Tamil periodicals like Vikatan, Kungumam etc. That will probably happen this week which will spread the word about our helplines. I am also getting contacts of FM channels which can broadcast the message about the helpline.

Other stuff
I talked to one Mr.Jawahar of Doordarshan and asked him if we can do a program on Right To Information on DD, he said we can do it. So I talked to Nityanand, whether he would be ok with doing a program on RTI on DD. He also readily agreed. Let us see how this one goes. This might have a good reach, since it will reach all over tamil nadu (But yeah, I am not sure who is watching Doordarshan of all the channels).

Monday, January 07, 2008

Accountability in GH - 1

I request you to go through three other posts on my blog too before reading this post.

Government General Hospital - I (Before the surgery)

These experiences actually started off the work we are doing on accountability in Govt hospitals. Prabha, my fiancee, has experience working on working on Children's health in villages, though, of late, there has not been much happening on the health front. Prabha is still very interested in Health issues, and hence decided to start working on accountability in government hospitals. These blogs will be essentially her experiences. But I am blogging those experiences here for 2 reasons that She doesnt blog and also because I am also involved to a small extent in these endeavors when it comes to parts where RTI is needed.

When we were having those experiences in GH while having Manjula admitted there, we filed an RTI application asking for details of waiting times in government hospitals. We asked them a list of all the patients admitted so far, their joining dates, the dates on which they were operated upon, type of surgery, whether the surgery was successful and whether the patient survived the surgery. We got a reply for this RTI application. The reply was about 10 - 15 pages. I have scanned and uploaded the first three pages.

If you look closely at the two date columns on these pages, you can see that, according to the data, almost all the patients have been discharged within 2 months of their admission. This itself made us suspect that the data is not true since we had personally seen patients who had been there in the hospital for more than 6 months. But a better give away is the way the data has been fudged. Almost all the patients were shown to be operated upon exactly 2 months after admission. It made us wonder, cant they even fudge properly?

And these were the precise words of Dr.Amal Joseph, whom we met in GH to discuss this data and to seek suggestions on what can be done. We got his contact through Dr.Rakhal who is part of Community Health Cell and had worked as part of Jan Swastha Abhiyan (Makkal Nalavazhvu Iyakkam) wherein AID India had also worked a lot. This doctor suggested that we directly talk to the head of the Cardio Thoracic department, and tell him that we are interested in helping with the streamlining of the patient admission process. When we were discussing other problems like rampant corruption, general hygiene of the hospital etc, he told us how he himself has to pay money to the stretcher boys 10 years back when his father was admitted there for surgery. When asked what the powers were of the hospital with respect to errant staff, he said that the dean had the power to suspend them. Ironically, when we were discussing this, a student of his, brought in a ration card, saying that the patient had not brought the original card and hence she was not able to get an MRI scan for the patient. After the student left, the doctor explained to us, that the patient was a girl who was continuously bleeding through her Vagina and her rectum, and so he had recommended an MRI scan for her. But even for this he had to get a permission from the Dean. The Dean, in turn, had asked the doctor to get an ok from the Secretary. The Secretary replied saying, that these permissions, need to be obtained from the dean, and that is the purpose for which the dean is present. This went on and it seems he had to get permission from a few other officials and finally the department which had to do the scan said that they were busy and that they can do it only today. And today when he sent the patient to the scanning department, they are asking for the ration card, which will indicate whether the person was below the poverty line. And it is at this juncture that the student had walked in. We left the room wondering, that if this is the situation of a doctor in the GH, we cant imagine what will happen to the poorest of the poor who do not even have the confidence to talk to a ward boy or an attender.

But coming back to the waiting time issue in hand, what we have in mind is some kind of token system where patients are given a token number, and are told that they need to wait for so much time, and a tentative date of surgery given. The patients can be asked to get admitted three days or 1 week before the date of surgery. They can always call up, quote their token number, and find out when they need to join. To improve transparency (and avoid recommendations disturbing the queue too much), the patients who are operated upon are updated on a website on a daily basis or put up on a notice board in the GH.

We intend to talk to the chief of Cardio Thoracic block about this. This meeting will happen in a day or two.

RTI Project updates - 5

Information Commission
Last week I was at the Information commission twice talking to Mr.Dhandapani, Registrar. After our meeting with the commissioner on 26th dec, last wednesday, I went and met Mr.Dhandapani on Monday (Dec 31th). He was not in a very good mood. He said he was filing a reply to a court notice to the commission and he implied that he was being disturbed with interruptions like me :-). He said that he was anyway planning to upload the decisions and hence asked me to wait. He asked me not to be anxious in getting the copies and to understand his situation. He said that there are some errors in decisions that have been already sent and hence he wanted to edit them before giving it to us. I was confused. How can he change an order that was already issued and sent to the individual concerned. But I didnt want to argue that day. He said he will anyway check with the commissioner and asked me to come and meet him again on wednesday. I left that day.

I went and met him again on Thursday 3rd January. He told me that he had talked to the commissioner and that the commissioner also suggested that we wait for some time. He said he will upload the decisions in a month and hence I should wait. I asked him how he can change decisions after they were issued. He said that though they were sent to the individual, now if he gives it to us, it will become public and hence he didnt want to give the uncorrected orders. I told him that we would be least bothered about any grammatical or oversight errors. He said that he understood that I would not mind, but the public will mind. I didnt want to continue the argument. I was very irritated but gave him a disappointed look. Then he said, ok wait for at least 10 days. This I thought was ok, and said, I can wait for 10 days. But he did not specify a date. I immediately looked at the calendar as if I was choosing a date to meet him again. I was hoping that would make him commit to a date. He said that in 10 days there will be pongal and hence I had to come after Pongal. Now I was wild, but still insisted on getting a date. He said come on 22nd. I said ok. But I told him that if on that day he doesnt give me the copies, I must be allowed to scan the. He also said ok. So I came back.

RTI applications
A quick listing of some applications which I had filed in the past and have missed putting it up on the blog would be in order. I had filed applications for the following issues.

1. About publicising complaint numbers by MTC.
2. Foreign trips made by MLAs (Reply received saying there have been only two such trips)
3. Foreign trips by councillor(Reply received saying there have been no such trips)
4. RTI asking for audit reports of Chennai corporation (No reply yet)
5. RTI about usage of garbage composting bins by Chennai Corporation
6. RTI with the personnel dept on why not a single awareness session has been conducted so far for the public

RTI for Passport
Sometime back Arun, a close friend and an active member of AID US RTI group, received a mail from one Jayakumar whose mother had submitted an application for passport a year back (18-Sep-2006) and was yet to get her passport. He himself was in the US and so he contacted Arun, about using RTI to get his mother's passport. So Arun directed him to me. So I filed an RTI application on enquiring the status of the application on 12th Nov 2007. Since I did not reply for a month, I filed an appeal on 14th Dec 2007. Still there was no reply. Around the end of december, Jayakumar asked me if his mother would get the passport before Feb, since his mother has to travel to the US for some important personal work. So I decided to go the passport office and talk to the PIO. I went there, spent around 1.5 hours, before finding the person who handles RTI applicatons. I showed her the RTI application and she immediately recognised it and said the people concerned were not able to find the applicaiton filed initially, and hence could not send a reply to the RTI applicaiton. For another half an hour she tried to locate the application, then came back to me and admitted that the department has lost the application that was filed initially. She also told me that since the Police verification report was clear, if a fresh application is submitted now, the passport will be posted in one day to the applicant. Their admission of the fact that they had lost it, was in itself a success since Jayakumar has written to the grievances dept of the Passport office many times without any success. So I called up Jayakumar and appraised him of the situation. He said he will ask his mom to send a new application filled-in application form.