Government General Hospital - I (Before the surgery)

Manjula is one of our employees. She is a teacher at a school AID India runs in Vembakkam block of Thiruvannamalai district, had to undergo an Open Heart Surgery (OHS). She is from a very poor family.We started enquiring about the charges, we got her cardiogram done,and showed it to Dr.Rex Sargunam, a doctor we knew. He referred us to the HOD of Cardio-Thoracic block of Government General Hospital(attached to Madras Medical College). He told us that it was a simple surgery and asked her to get admitted. At that time, we were told that normally patients have to wait for 2 months to get this surgery done,but since we were referred here by Dr.Rex, the HOD told us that this will be done in one month. We got her admitted around the 17th ofAugust. She was admitted, but once we entered the ward, we saw that many of the patients there did not have beds. They just had to buy a mat on their own and get a place somewhere on the floor. This surprised us. So we went to check when Manjula will get a bed. We were told, that we will get one as soon as one becomes empty. That too,after all those who were already on the floor before us, got the beds.With not much option she settled down on a spot on the floor. Then wewaited and waited. Nothing happened for almost 3 weeks. Forget thesurgery, there was no sign of getting a bed. Then Manjula was asked to take a test. Which she did. After that a couple of more tests. Again waiting. Then again no activity for 1 more week. So we went and met the HOD again around mid September, asking him when the surgery will be done. He said that before the end of october the surgery will definitely be done. We again waited.

All through these 4-5 weeks we kept visiting manjula almost once everyweek. We heard a lot of stories that she picked up from others. We were told that patients were waiting for 6-7 months to get their surgery done. She also once told us, how a single death, resulting from an unsuccessful operation, casts a gloom on the whole ward. We also once heard, that a lady fell off from her bed during the night and hence she died. Since then, the nurses there did not allow patients to sleep on the beds at night. She also told us, that the toilets had to be cleaned by patients themselevs since the ayahs there refused to do it. Apparently, they tell the patients that since they are the ones using the toilets, they should clean it themselves.

Normally a list is prepared for each day on which surgeries for this ward happens. The list is announced the day before the date of the surgery. The first date on which her name came on such a list was 5thSeptember. She was taken to a room outside the operation theatre,where she was asked to wait. We reached there before 8 AM. She was taken to the waiting room outside the theatre at 8.30. We were waiting. There we learnt a thing. Normally the number of patients listed for the surgery will be greater than the actual capacity. This is to ensure that just in case, a surgery cant be done to one patient due to change in their body parameters, then one of the waiting patients can be operated upon. Though this is a pretty good idea, it becomes very tough for patients who are taken to the theatre and brought back without doing the surgery. We can understand if this happens once or twice, but what if it happens 6-7 times. We learnt of a lady who had been to the theatre and back 7 times. Manjula herself had her 4th unsuccessful visit to the operation theatre on 19th October.Out of these 4 visits, on 3 occasions she was asked to get some medicines or some devices needed for the surgery. We are yet to investigate whether it is right on their part to ask us to buy medicines, since it is supposed to be free for the poor. But the doctor doesn’t write the medicines as a formal prescription. He writes them on small bits of paper (which are slightly bigger than stamps) and gives it to Manjula. The first time we spent about 1500 rupees. The second time 75 rupees and 1800 Rs for the third time. What we didn’t understand was, each time they were a different set of medicines or other devices. Assuming the ones that we were asked to buy the second and third time, what would they have done without these if the surgery had happened the first time itself.

Try to imagine this. Everytime she is called for the operation theatre she has to stay on empty stomach from 9 PM the night before (not even water should be consumed). She will be taken to the theatre at 8.30 AM and made to wait for 1.5-3 hours in a white cloth draped around,sitting along with 8-9 other patients. At the end of all this, she is asked to go back to the ward.

It has already been more than 2 months since she was admitted. And this is after, they telling us that it will happen quickly since we have a reference from Dr.Rex. The Madras Medical College claims that the Average Length of Stay was 10 days in 2004, 2005 and then reduced to 9days in 2006. (Source: http://www.madrasmedicalcollege.edu/home.html. On that page click on Hospital Statistics tab on the left hand side).

Of course there are other usual complaints of every low level employee asking for bribes at every possible chance. On Oct 17th, when we were waiting, while Manjula was waiting outside the operation theatre, we were talking to a lady whose husband had to undergo a surgery and was presently in the ICU. She expected them to move her husband to the post operative ward soon, but she was telling us, that she has paid Rs 500 to each of the ayahs and attenders there.Her husband has a textile company in Tiruppur. She told us, that they had to wait for 4 months, during which they lost their regular income.More than that, she had to shell out money at every turn. And she had to live in the GH along with her husband for 4 months.

We are mentioning the above meeting with the woman, only to tell you,that the time taken for Manjula is not an isolated case. Talk to anybody in the ward, or to anybody who has had his surgery done, and everybody would say that it would have taken a minimum of 2-3 months.In the face of this, the numbers given on the website is a lie. We understand that the numbers on the website is the average of all the patients in the hospital. But the scenario in this block is entirely different.

The hospital’s maintenance is also generally bad. You can always find waste dumped here and there. There are places which stink of urine, areas where cobwebs have not been cleared for months. And we were shocked to see that there are no dustbins in any of the floors. Those who come to the hospital to visit patients are forced either to leave the garbage (like used paper cups, plastic plates, covers, leftovers etc) in some corner, or throw them out of a window. People generally spit in all the corners and on the stairs. There are no spittoons available. No wash basins for people to wash their hands. But considering the fact that patients don’t get even beds to lie on, expecting all this is probably too much from the Government Hospital.

RTI on awareness sessions conducted by Personnel dept

Sec 26(1) of the Right To Information act, 2005 says the following.

26. (1) The appropriate Government may, to the extent of availability of financial and other resources,—
(a) develop and organise educational programmes to advance the understanding of the public, in particular of disadvantaged communities as to how to exercise the rights contemplated under this Act;
(b) encourage public authorities to participate in the development and organisation of programmes referred to in clause (a) and to undertake such programmes themselves;
(c) promote timely and effective dissemination of accurate information by public authorities about their activities; and
(d) train Central Public Information Officers or State Public Information Officers, as the case may be, of public authorities and produce relevant training materials for use by the public authorities themselves.

To see how far this has been done, I filed an RTI application with the PIO of the Personnel and Administrative Reforms Department asking for details of training, awareness camps and the like that they had conducted to fulfil the requirements of this section. The information I received can be viewed here.
One look at the sheet says there have been no awareness programs for the public AT ALL. That means, if not for NGOs or activists working on RTI, people would have had to find their own way around. Even as a formality, the department has not conducted any programs for the public. This shows how much the department wants people to use the act.

Fines imposed for Traffic Violations - RTI application

On July 23rd 2007, I had filed an RTI application with the Home department (Which looks at transport too) asking for details of Fines collected from the public in Chennai for various kinds of traffic violations. There was a prompt response to this, and a traffic constable had come to our apartments on 12-Aug-2007 to personally give me the information. Since none of us were home, he told our watchman that he had come looking for me. This was in the evening. After my mom returned from her evening walk, the watchman told here that a policeman had come looking for me. My mom got worried. The problem was that the watchman didnt tell my mom that it was a traffic policeman. So when I returned home, though she was not upset or anything, she asked me why I was involving myself in such things that leads to a policeman to come looking for me. I told her that there is nothing to worry just because a policeman had come to my house (even I didnt know it was a traffic policeman). So when that guy came at 9.30 PM and gave me the info, only then my mom was happy. :-)

I have published the information received here in this link for anybody who might want to look at it.

My first RTI success

About 6 months back, Chandrika (who used to work with me in AID India) had gone to a village called Vada Iluppai in Vembakkam block of Thiruvannamalai district. There she met a widow who was had to get her widow pension but till then had not, for various reasons. She also told Chandrika that she had already given an application to the VAO (Village Administrative Officer) after giving him some money but nothing has happened yet. Then the second time, I had also gone there with Chandrika and we were discussing what was to be done. We always had RTI at the back of our minds, but we thought let us file a fresh application. So we got a new one purchased, filled up necessary details after consulting with an official in Vembakkam BDO (Block Development Office). We had taken the signature of the Panchayat leader, which was necessary, took a medical certificate and a photo and then went to the Cheyyar Taluka Office (Widow Pension Applications are dealt only at Taluka offices). While we were doing this another woman approached us for the same help and so we decided to help both of them. We filed the applications and we were promised that this application would be looked at in one month and would be acted upon suitably. Then started the repeated trips to the taluka office. After a month, there was no news. The procedure for sanctioning would involve a visit for checking the validity of the application and whether the person deserves it. Even this had not happened in one month. We went back but things did not move. After that Chandrika moved to Rajasthan. I visited them a couple of times. In between the official changed. So this new official blamed the old official and again told me that he would complete the procedure within two weeks. Again nothing happened. I visited again. This time he gave me the contact number of the Revenue Inspector (who actually does the checking) and asked me to contact her. By this time I had decided, that I must use RTI. So I came back to Chennai and sent an RTI application. They refused to accept the courier and it returned. So I went again. I wanted to find out why it was returned. I was told by the person in despatch, that But I had mis-typed Cheyyar as Seiyar and hence it was returned. They told me that this looked like Seiyur (which is another Taluka). But I explained to them that Cheyyar is in Thiruvannamalai district, but Seiyur is in Kanchipuram district. And I had clearly mentioned the district name. If that was not sufficient, I had also given the phone number of the office correctly. The person there couldnt answer much. Then I personally filed the RTI on that day and got an acknowledgment. And this was on 29th Aug 2007. I received a phone call on 26th Sep 2007 from the Tahsildar himself, to tell me that both the people were found deserving and hence Pension has been sanctioned and that they will receive their first pension on Oct 1st 2007. He was very courteous and asked me about what I was doing. And that it was very good that the NGO I was working in is working in Education etc etc. Today I received a letter saying the pensions have been sanctioned. This is within one month of filing the RTI.

As RTI has always been meant to bring about a change, I count this as my first success with RTI. I have received information before from Public Authorities, but this is the first time there is a direct visible benefit of RTI.

In another village, while I was doing an RTI awareness session in a village, I had helped a person file an RTI on his ration card applicatin. It has been 2 months since then. I need to follow up on that next.

An RTI article

Here is an article I wrote for a magazine. This was written in the first week of July. I am posting it here, more because it serves as a report of what I had done till then on RTI.
_________________________________
Some abbreviations used in the article
RTI - Right To Information
PA - Public Authority
PIO - Public Information Officer
SIC - State Information Commission
AA - Appellate Authority
NREGA - National Rural Employment Guarantee Act


When I started off working on RTI I had an opinion that since the details of the act will take time to percolate to the rural areas, the cities' public authorities will be doing much better that the rural areas. But in my experience the city has been doing worse than the rural areas.

In Thiruvannamalai district, I had filed a few applications. Among them there were a couple of NREGA related applications asking for Muster Rolls. I also filed an application with the collectorate asking for details of Indira Awaas Yojana beneficiaries in 8 panchayats. For all of these I received pretty good response. They were prompt in sending me the replies.

It is only in Chennai that getting information is becoming a problem. Here again I filed 4 applications, one was in the last year and 3 more in recent months. Out of these three, two did not evoke very good response. I have talked about these 2 in detail here.


MPLADS

I had filed an application with the PMO on 18th May 2007 asking for the details of schemes implemented under MPLADS by the 3 MPs of Chennai North, Chennai South and Chennai Central constituencies. The PMO's office forwarded the application to the Ministry of statistics and Program Implementation on 24th May. This ministry sent me a letter saying that the exact details of these MPs' MPLADS scheme is available only with the Chennai Corporation and hence forwarded the Application to the Corporation on 5th June. Today is 11th July. And not a single word has come from the Chennai corporation.

Illegal Hoardings RTI

I had filed an RTI application with the Chennai corporation on 20th Apr 2007. The application was regarding the action taken by the illegal hoardings put up by various political parties on a 3 KM stretch on Arcot Road from Laskshmi Nagar bus stop to Virugambakkam and also some general questions on the procedure and penalty for putting up such illegal hoardings.

30 days passed without and i filed a first appeal with the Corporation commissioner on 21st May 2007. On 30th May, I received a letter saying my application has been forwarded to PIO Zone-VIII. On 11th June 2007, I received a letter from Revenue officer, Chennai corporation, saying that the information I had asked for can only be got from the Chennai Collectorate and so I must contact them for information.

Experience with the State Information commission

Since this was a clear violation of the act I filed a second appeal with the Information Commission. For that I met the registrar of the Information commission. In the second appeal I had appealed for an order to provide the information and to impose suitable penalty. While talking to him, he started telling me that I cannot ask the SIC to impose penalty. I tried to explain to him, that I have every right to "appeal" for a penalty, but it is up to the commission to actually impose it. He then asked me whether my intention was only to get the information. I said my intention is both to get the information and also get the RTI system working smoothly, which will need proper orders by the SIC, so that the corporation doesnt repeat these mistakes.

Then he went on to tell me about how in one or two cases where they had imposed penalties, recovery was a problem. And that those Public Authorities had gone to court against the imposition of penalties. So I generally tried to check with him as to how many appeals come to the SIC daily on an average. He told me that he doesnt count appeals separately but only along with the regular RTI applications that come to him. I wanted to get an idea of the 2nd appeal disposal rate so that we can look at whether there will be backlog of cases pending with the SIC thereby leading to a situation in SIC similar to that of the courts, but I could get no concrete information.

Moreover, 3 months back I talked to the same person about uploading SIC decisions on some website where anybody can look at the decisions. This will help activists to fight against wrong decisions, so that precedents are not set. At that time, I was told that it would take 2 more months. When I checked about that now I was told that it has not yet happened owing to lack of manpower.

And about the second appeal regarding the Illegal Hoardings, I did file a second appeal, and he said suitable orders will be passed. But a week later what I got was a copy of the letter sent to the chennai collectorate asking them to send me the information that i had asked for. But no order has been passed to the chennai corporation for flagrant violation of the RTI act on two counts.

1. Not providing info within 30 days.
2. Failing to forward the application to the PIO concerned.

Neither did the SIC pass an order to chennai corporation to forward the application, or impose a penalty on them. So I went to the Information Commission to ask them why no orders have been passed. He told me that orders would be passed after I receive the information from teh Chennai collectorate. I dont see any reason why they need to wait till the information is received, since the corporation has already violated rules. Moreover, it is not the job of the information commission to forward applications. They should have just ordered the chennai corporation to forward the application. The tussle will continue.

The SIC is the backbone of the act, since their decisions are the only deterrent and the only pushing factor for PAs to give information. If the SIC is seen as lenient, the PAs will happily violate the act knowing fully well, that no action will be taken. But if the SIC acts strictly, PAs will be forced to give answers. Thereby leading to a better implementation of the act. But the process to a transparent and accountable administration wont end there. But one hurdle would have been overcome then.

Spreading awareness about the act

Apart from my own attempts at asking questions through RTI, I am planning to spread awareness about this act among the slums of Chennai. The success of this act lies not in just one person asking questions, but in a large number of people asking questions. So, I was planning to visit a slum and try to find out the problems that they have with the government and probably help a couple of people file their applications. In that process I will make sure that all the people in the slum know that such a thing is happening. If they see that this is working, everybody who has a problem with the government might want to sort it out through RTI. At that point I might conduct an awareness camp in the whole of the slum.

As a part of this I visited a slum near my office, the day before (13-Sep-2006). Just when I was wondering whom to approach in the slum, I saw a lady throwing garbage at a corner and she was complaining to herself abt something, that I couldnt properly hear. So I immediately went up to her and asked her what the problem was. She told me that since there was no garbage bin, the garbage just keeps flying away here and there thereby causing a lot of convenience to their slum. She also told me that there used to be a garbage bin here but was removed when the road was being laid last year. So I thought this might be a nice place to start off the RTI campaign in this slum. I explained to her that I am from an NGO and can help solve problems with the government. I told her that there is a new act through which you can get info from the government. I am not sure if she understood the part about Information, but I told her that in effect she needs to file an application with a government official and asked her if she was ready. She said yes, I told her that I will come back in two days with the applicaiton.

The next day I went and took a snap of the place which is being used as a garbage dump. There is also a water pump very close to it. Somebody kept a cycle rickshaw (See picture below) near the dumping place to make sure that garbage doesnt fly in that particular direction. I am planning to file an application asking them the rules abt Garbage bins in the city, why this garbage bin was removed and how they are going to solve the problem.

My first RTI Application - Received Info

This is a long overdue update on my blog. Anyway here it is.

I got a reply from the Town panchayat for the RTI application that I filed well before the expiry of the 30 day deadline. I got the reply in the end of august, and the reply was dated 21-Aug. That was impressive. It seems that according to the rules, the roads need to be relaid every three years. I had asked for the details of the work done in the last one year, and the reply was that no work was done in the last one year. Though for the question as to when the work will be done now, they have replied saying that the tender date has been fixed for 28-Aug, and that the road will be completely repaired in three months. Let me see what happens.