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)

Government General Hospital - II (On the day of surgery)
Corruption complaint against a government hospital

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.

RTI Project updates - 4

Meeting with the State Chief Information Commissioner
Our meeting with the Tamil Nadu Chief Information Commissioner (will be referred to as CICr hereafter) went pretty well. He was very co-operative. He explained a few things about how they handle applications, petitions etc. I will try to mention a few things here.

1. He said that there were people who did not understand that RTI is an act to get information. So they just send in a letter mentioning a grievance. There is not much the SIC can do on such things, though the CICr said that he normally sends a letter to the department concerned, requesting action on the grievance. Sometimes, the grievance does get resolved.
2. He talked about how the focus is on getting the information asked for. So when somebody files an appeal with the SIC immediately after the 30 days expiry of filing RTI application (without going in for appeal with the AA), such appeals are not ignored, but the SIC asks the PIO concerned to give the information.
3. He also told us that in most cases of appeal, where the facts are obvious from the letters, then an order is passed without calling for an enquiry or personal appearances.

When asked about getting copies of orders passed, he told us that they have passed many orders without calling for enquiries, in which case, though the orders can be obtained, the background papers like the initial RTI application or the replies from the PIO wont be available immediately. The reason is that the background papers are filed separately from the orders and hence a mapping will be tough. (e.g) suppose you pick up a decision and you want the initial RTI application. The RTI application is definitely present in the mounds of paper in the office, but there is no way you can directly pick up the RTI application after looking at the order order. Hence it will be tough for getting details of all the orders passed. But he said that in cases of enquiries held, the order contains a brief summary of the case and the arguments by both the arguments. It will then contain the judgment given. Usually this order is given in 2 pages. He said we can get the copies of all the orders passed where enquiries have been held. Hence this is what we intend to scan and then analyse.

RTI Applications filing

I filed two applications this week, one in which I had asked for details of public toilets and urinals in Chennai. The other one is the expenses incurred for celebrating Mr.Karunanidhi's 50 years as MLA in the secretariat.

Corruption complaint against a government hospital

This post started off as a reply to the comment posted by Suneel for my post (can be seen here). But then the comment was getting bigger and bigger and hence I decided to have it as a separate post.

The comment was about the cause of the problem. I think the public is also part of the problem. But I really wonder what makes systems work, what makes systems fail. Take public transport of Chennai for example. From a user point of view there is no corruption. Suppose for the next bus stop the fare is 5 Rupees (which is the case in deluxe buses), the conductors can collect just 3 rupees, not issue any ticket, in which case he can pocket all the 3 rupees. Which will be much less than the incentive on a Rs 5 ticket, he would have got if he had been honest. The passenger will be happy since he will be paying 2 rupees less. But I dont see this happening. The conductors always give the tickets. I am explaining this just to see why this system is working without corruption. If suddenly some checking inspectors come, why cant they also be bribed. This is not happening. By the way, when I travel in private buses in villages, there are many times, the conductor is ready to take just 5 rupees instead of the actual 7 rupees fare, if I am ok with not getting a ticket. Looking at these private buses there are various possibilities as to why there is no corruption in MTC buses.
1. There is something in the ticket system of MTC, that makes it work without corruption.
2. It is just the culture that has been built over the years.
3. It might be again because the public would never accept not having a ticket, in which case again the buck stops with us, when it comes to corruption at other places.
4. It can also be that devising a corruption proof system is easier for ticket collection in buses but mot so easy in other places.
5. It could also be that whether a system is corrupt or not corrupt depends on th people at the top (Here I am talking not just about their intention but also their ability)

When it comes to these hospitals, I somehow feel change can come in, if there is the will in the highest authority. Probably nobody wants to ruffle a few feathers. Here again the public also need to be blamed. Once they are out of the hospital, they should write complaints to DVAC, or call them up. Their numbers are displayed everywhere in the hospital saying bribes should not be given and that if any staff member asks for money, the can complain to this number. But in a hospital it will be dangerous if you complain while the patient is still in the hospital, since they might do the patient harm. What I suggest is that they keep a note of all the bribes they pay, date and time wise. Once they are completely out of the hospital they can launch a complaint.

Which is what i did with "Kasturba Gandhi Hospital For Women & Children" at Triplicane in Chennai. Bharathi is our office accountant. Her friend was admitted there for delivery. And my friend was helping her with getting admitted and other formalities. After delivery the baby had jaundice and hence there were problems. So my colleague eventually moved her and the baby to a private hospital. But during those three days she had to pay close to a couple of thousands as bribes to various people in the hospital. Hence she talked to me, and we together drafted the complaint and filed it. The complaint can be seen here. We are waiting for a reply.

RTI Project updates - 3

RTI Awareness session in Saidapet slum

A lot of this week was spent on preparing for this RTI awareness session in a Saidapet slum that happened on Saturday (22^nd Dec 2007). This slum was chosen because AID was already running an area learning centre there, and hence we had a contact person there called, Koteeswari.

Preparations for the awareness session included, preparing handouts, talking to a street play troupe (a group of students who were inteterested in doing a kit or a street play for RTI), getting some posters used by TN RTI campaign in 2006, getting a few display charts ready to be used for the session. We (ChennaiRTI & I) had also prepared templates could be used while drafting RTI applications in the slum. We got this ready in Tamil so that we can copy from it while drafting applications. And we had prepared a list of PIOs and AAs for issues that we thought are the most likely to arise in a slum.

The day before the session, the street play troupe backed out saying their members have left for their native places for Christmas holidays. I didn’t expect this. I knew that the street play troupe was very important for the success of the session, since it is very difficult to gather people together otherwise. I had this experience before while doing awareness sessions in villages. But I couldn’t do much if they say they cannot come. But I decided to go ahead with the session anyway. I had taken printouts of posters, handouts, display charts etc. In the evening around 6, Prabha and I went to the slum. There along with Koteeswari, we distributed handouts about the session the following day. I had 75 handouts ready and we distributed almost all of them. We would have informed about a hundred families. This took about an hour. There were a couple of people who said that drainage was the biggest problem they had. They did not have a drainage connection for the slum. I said all these issues can be handled using RTI and hence asked them to come to the session tomorrow. One lady in particular was very excited and said that she will definitely come tomorrow to discuss the drainage issue. But she was the only one who gave such a positive response. Otherwise there was not much response. So I was not expecting a lot of people the next morning. But I had thought that at least 20 people will be there. Little did I know the shock that was in store.

The next day (Saturday) morning, I reached the place at 9 along with Varath. Prabha and Bharathi, a full timer with AID TN, were already there with the stationery and all the other stuff I had left in the office the previous day. And there was not a single soul at the place we had announced. Though this in itself was not surprising, when I went around telling all the people to whom I had distributed handouts etc, and everybody was like “Yeah, we are coming. You go on and we will follow you”. This went on for about 20 mins. But after all the effort, there was just one lady who had come. This was a bit frustrating. Almost 1 week of effort for the session, all for just one lady?? I was asking myself this. By then, a few other ladies turned up. Lokesh had also joined us by then. There was a small hotel nearby where some young people were having their breakfast. We tried to call them. A couple of them came. We somehow managed a group of 10 people. Supported by others who were with me, I started off the session. I knew that the group had very little attention span, and so I didn’t go into any of the details. I just told them that a new act had been passed, wherein applications had to be replied in 30 days and if not, the officer could be fined up to Rs. 25,000. I tried also to explain that the new act is about “Information”. But I felt that none of this went across well. I missed the street play troupe. I spoke only for about 10 minutes. While I was talking some more people had gathered. We had around 20 people mid way through the talking. And after 10 mins I stopped. I told them that we would help them in filing RTI applications if they had any issues with any department of the government. I could see the whole session winding up in another half an hour. This time again, I was proved wrong. But this time I was happy I was wrong.

Once we started addressing individual issues, one lady there came to us saying she had applied for a ration card about a year back, but nothing had happened since then. We took this up and Prabha started drafting an RTI application for her. Soon, another lady came up to us saying that she had not got her father’s job after he passed away. Varath handled this case. Then a couple of others came. Soon all of us were busy. And to our utter surprise there were people waiting for us to handle each of their cases. And many of them were people who were people who were not part of that initial 20 who heard my 10 minutes talk. I knew what word of mouth publicity meant. After a few applications, Prabha and Bharathi left. Varath, Lokesh and I were drafting applications for sometime. After some time Lokesh left. Varath and I were still there. Soon it was hot outside on the road and hence we moved to the temple. There we sat down and continued drafting applications. When Varath and I ended this at 1, we had drafted 16 RTI applications by then. Not a bad number considering that we started with only one woman who was ready to listen to us.In the end the awareness session was more an application filing drive and less an awareness session. In the future, I intend to talk to NGOs who work in slums and use their base to do the awareness sessions. I should also use SHG network which is very widespread in Tamil Nadu to take forward this awareness. While we were distributing handouts on a door to door basis, Prabha was surprised to find an AIDWA member who recognized her. We should be using more such contacts so that we actually do awareness sessions in the future.

After the volunteer training last week, I had hoped one of them would take up responsibility of follow-up work for this awareness session. But nothing of that sort happened. None of the volunteers attended the session. Hence follow-up work for this slum, rests on my shoulders. I must think of ways to find volunteers who can do this.

Email and phone helplines:

Also, this week saw the start of email and phone helplines for RTI. The number is 9789819014. The email ID is TNRTI@yahoo.com. For now am planning to spread the word about these helplines through email forwarding. We also distribute this number to people in the slums where we conduct awareness sessions.

Working with the commission

Nothing much happened this week with respect to the state information commission. We had wanted to meet the Chief Information Commissioner this week to discuss how we can get copies of their decisions. Hence I went to the SIC to get an appointment with the Chief Information Commissioner. He said he can give me time on next Wednesday (26^th December). So I said ok.

So we will meet him the coming week to place before him our demands.

RTI Project updates - 2

The volunteers training that was initially scheduled for saturday(yesterday) was shifted to sunday(today). On Saturday, I conducted an RTI training for AID Chennai Full timers. About 15 people attended the training. Then there was a training for volunteers on Sunday (5 of the 7 people who initially agreed attended the meeting).

Training for AID Chennai Full timers
This training happened on saturday (15th December) went on for 2 hours. There were a lot of questions about where RTI can be used. I did this before the training for volunteers, since I thought that it can be some practice for me. Overall, the training went off pretty well. Many told me that the training was very useful and informative. One particular person said that it was very useful, though when she walked she did not have much interest. I think a good amount of that credit should go to the fact that RTI is such a wonderful tool which can have an impact on many day to day issues that individuals face, and hence when they see that such issues can be handled using RTI they are very impressed. The audience in this training was very varied. At one end there were people who had only completed 12th standard, and at the other end, there were people who had completed Masters in Social Work with a few years of experience in the development sector.
The agenda was that, for the initial 45 minutes, the basics of RTI act was explained using the presentation(that can be seen here, though I dont know how anybody can see those tamil fonts on the net. Anybody who needs a copy can mail me.). As the name suggests, this PPT is in both English and Tamil simultaneously. After the basics were discussed, I discussed with them a few RTI success stories, for them to get an idea of what kind of cases can be handled, and what kind of information can be accessed, and what is the scope of impact that the RTI can have. This went go on for about half an hour. This was a pretty interesting one, where in many questions were asked like "Can RTI help if buses are not coming on time?", "What can we do if one person who is married has ditched his wife and married somebody else. The police intervened and asked the man to pay alimony, but the man is not paying up." One person asked "Can we use RTI to speed up processing of cases with the courts". There was a lot of discussion on various issues, but public transport was a dominant theme. The final session was a mock application drafting session, wherein, I ask them to think of some issue, and then draft an RTI application to address the issue. Once the applications were ready, we asked each individual to read out their application, and then discuss what could have been done better, etc.

Training for Volunteers
On 16th December, there was a training at AID office for volunteers. 5 volunteers attended the training. The training went on for about the 2 hours. With similar agenda as the previous day. But one learning from the previous day was that, starting off with the Presentation is somewhat abrupt. So I initially gave them a quick overview of, application and appeal processes, in about 5 mins, and then started the presentation which contained the details of each of the processes.

Once the training was over, we had a discussion on how publicise our awareness session in the slums. 4 members of the chennai RTI group, who were part of the campaign in 2006 were also present. I had proposed that we should have an awareness session next saturday (22nd Dec) in one slum. So there was a general opinion that we should have a contact point in the slum before we do the awareness, as that will help them trust us. Hence, Sharadha and I decided that we will do that work during the 1st two days of the week and then decide on the slum.

Working with the commission
This week, I went to the commission, and met Mr.Dhandapani, to find out the status of my RTI application asking for the soft copies all the decisions they had made till date. Since they had not replied within 30 days, I had already filed a first appeal too. But still there was no response. So I went and met this person. He was not very keen on talking to me, since he appeared busy. He said that soft copies of the decisions will not be available for the next two months atleast. He showed me three closed cardboard boxes with computers, saying, these were yet to be opened and only after they are opened this work can be done. Today after the volunteers training, the 4 member of the ChennaiRTI group had a small meeting where we discussed what needs to be done about the commission. Then we all decided that during one of the weekdays, we will go and meet the Chief Information Commissioner (Mr.S.Ramakrishnan) and discuss this issue and arrive at a means of getting a copy of their decisions, which can later be analysed.

Email and phone Helplines
We had decided to start an email helpline and a phone helpline. The phone helpline will be open on saturdays. The phone helpline will start from next Saturday. Publicity for this will happen through emails and through the publicity posters and handouts that we will prepare for the awareness sessions. The helpline phone number is 9789819014. The email ID will be tnrti@yahoo.com. The email helpline is, of course, open right away.

RTI Project updates - 1

I met a group of 3 enthusiastic people today. Varath, Sharada and Lokesh. They had already worked on the TN RTI state wide campaign that happened in 2006. Hence I had called them up to meet them. They readily agreed and came to meet me. Varath, Sharada and I met on saturday, to discuss what we can do for RTI on the awareness front . Lokesh joined in later and left after a while . We discussed on how and where we can conduct awareness sessions, and finally we decided that we will initially do it in 5 slums in Chennai. We discussed on materials that will be needed for the slum awareness session. Sharada said she can talk to HRF and get the publicity materials that were used last time. That we should do a skit in the slum was agreed upon, though the details need to be worked out. I have also called for volunteers for this RTI awareness sessions. The idea is that each volunteer will be assigned a slum, and once the awareness session is over there, that particular volunteer will do the follow-up work by visiting it once in 2-3 weeks. So far I have found about 5-6 volunteers. The training for these volunteers will happen next Saturday (Dec 15th 2007). That will be a 3 hour session.

We also decided that we will run a help line for RTI to provide help over phone. This will essentially be a mobile phone number, to which people can call in with queries about RTI. We plan to have it open for 3-4 hours every saturday with each one of us taking turns at handling the calls every week. This will start soon and we have decided to publicise this number at all the awareness sessions and also through local area newspapers.

About working with the commission, we decided that we will meet again to discuss that separately when Rajesh (who also participated in the 2006 RTI campaign, but could not make it to the meeting) and Lokesh can also join in.

Meanwhile, I am designing a poster, for use in the awareness sessions and also for general publicity of the helpline. That will also be ready by the time the slum awareness sessions start. A ppt has been readied for use in the volunteers training and a set of case studies need to be chosen, which I can use during the training for volunteers.