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.


Jayan said...

Hey Madhav, the first two links dont lead to the earlier posts. Check it out.
- Jayan

V Madhav said...

Thanks jayan. Fixed it.