Why is Mumbai abandoning its civic hospitals? #Healthcare


 – Rediff.com India News

By deserting public hospitals we are dismantling our public health-care system, says Dr Sanjay Nagral. | Why is Mumbai abandoning its civic hospitals?

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Why is Mumbai abandoning its civic hospitals?

May 09, 2013 10:56 IST

By deserting public hospitals we are dismantling our public health-care system, says Dr Sanjay Nagral.

The recent story of babies with heart defects dying in Mumbai’s [ Images ] civic hospitals while the procurement of a heart-lung machine was delayed is tragic and shocking.

The heart defects in these toddlers were eminently correctable by timely surgery, which not only would have saved lives but also lead to a normal quality of life.

Unlike bypass surgery, which may add a few years to life, surgery for repairing congenital heart defects can translate into a normal healthy life span. Many readers are likely to have dismissed it as yet another chapter in the now familiar media exposes on the crumbling systems in Mumbai’s public hospitals. And we will all soon if we already haven’t forgotten about these babies and their cruel fate.

Mumbai’s civic hospitals boast of some of the oldest and finest cardiac surgery departments in the country. A lot of the early pioneering works in cardiac surgery in India [ Images ] –including the earliest successful heart operations — were performed at KEM Hospital‘s cardiac surgery department. Many of us who have trained in KEM’s surgery department have been beneficiaries of this great legacy.

Even today Mumbai’s civic medical colleges and hospitals are considered amongst the best in the country, both for undergraduate and postgraduate studies. Mumbai’s civic budget for health is one of the highest in the country and the teaching hospitals get a lion’s share of this.

So why is it that the purchase of a lifesaving heart-lung machine gets delayed for so long and it takes a newspaper expose for the authorities to respond?

Is it all about bureaucracy, red tape and indifference of some officials?

It is indeed tempting to think so for this is an easy, simplistic explanation. We can then momentarily feel sad, perhaps a little outraged, rationalise it and go back to the comfort zones of our daily lives. But there is more to it.

And that bit is not about some inefficient civic official, it is about you and me.

Public hospitals in Mumbai were once the heart of health-care in the city. Except for the few super rich who would seek services in a fringe private sector a large majority of the population including the middle class were treated in these hospitals.

Check with your parents and grandparents, and they will tell you this. Over the years a burgeoning private sector started attracting larger and larger sections of the population.

Today most people including the poor seek health care in the private sector which is perceived as ‘efficient’ and of ‘better’ quality. The middle classes have largely abandoned these hospitals and even the poor seek their services only for major illnesses often after being bankrupted in the private sector. Thus, these hospitals have essentially moved out of the imagination of those who shape public opinion.

A majority of the doctors trained in these institutions seek careers abroad or in the private sector. They have largely become training grounds for nourishing the private health- care industry. And finally no bureaucrat or politician now seeks treatment in these institutions, preferring to get their treatment funded at private institutions.

At the Bhabha hospital in Bandra — one of the largest civic peripheral hospitals where I work part time as a surgeon — there is a predictable pattern to patients brought to our casualty with accidents. Those who are well to do will often be whisked away by their family and friends to nearby private hospitals, whereas the poor will continue to be treated with us.

Thus in the bomb blasts of 2006 most of the victims including those with serious injuries were transferred to private hospitals since they were from the first class compartment. In the previous year’s riots and floods we managed the victims.

Many years ago when I was at KEM I would treat a large number of friends and their family; people like you and me. Now I treat a large number of maids and drivers of friends at Bhabha, whilst I treat their employers in the private hospitals I work with.

A few years ago when a senior journalist friend chose to get himself operated at Bhabha a large number of common friends expressed surprise and even admiration for his act of ‘courage’.

In a subconscious collective act we have abandoned these institutions to those ‘others’ who inhabit a different space, who have no voice, clout or energy to fight the battle for decent health-care.

The parents of the kids fortunate to have their hearts fixed may thank the newspaper and the journalist who broke, and followed up the story. The act of getting a few private hospitals to do the pending cases is but only a temporary solution.

Even worse, it strengthens the belief that such care can only be provided in the private sector. Some of the private hospitals will seize the moment to actually market themselves.

The specific reason for the delay in sanctioning the heart-lung machines could have been a slowly moving file, an indifferent official or even a lack of follow-up from the departments concerned. But each time a life-saving ventilator doesn’t work, a CT scan is not available for a young man who has fallen off a train and a young pregnant woman dies, as she is transported from hospital to hospital in ramshackle ambulances, a media story cannot correct the problem.

Unless we realise that by abandoning these hospitals we are complicit in the process of dismantling our public health-care system. Whether we like it or not, at some stage in our lives we need the services of public hospitals; what if you are knocked down on the road and carried by passersby to the nearest public facility?

The heart-lung machines have probably been temporarily procured and unlike the unfortunate ones who died, some of the kids will now live to tell the tale of the holes in their hearts. Many years later when they grow up will there still be a long queue for poor kids born with heart defects?

Their fate is inextricably linked with the value we give to the development of an efficient public health system. And that in turn will be determined by whether we relate to our civic hospitals as our own and are outraged by its inadequacies and indifference.

The holes in the babies’s hearts is currently a gap in our collective minds.

Dr Sanjay Nagral is a consultant surgeon, department of surgical gastroenterology, Jaslok Hospital and Research Centre, Mumbai. Photograph: Sahil Salvi

Dr Sanjay Nagral in Mumbai


#Mumbai – 20 children have died this year waiting for open-heart surgeries at KEM Hospital for red tapism #WTFnews

Number of patients in wait-list: 700;

Number of heart-lung machines: 1

20 children have died since Jan 1 while waiting for their open-heart surgeries at KEM Hospital. The reason: the BMC’s infamous red tape

Lata.Mishra @timesgroup.com , Mumbai Mirror March 25, 2013

CHILD’S NAME: Aditya PARENTS: Kanchan and Rakesh Rajat, Kandivali residents FATHER IS: a peon at a private firm WAITING SINCE: October 2012DIED ON: January 30, 2013
Nasir Sheikh spent eight months last year waiting for a call that could save his oneyear-old son Mohammed’s life. The boy had a hole in his heart and a narrow valve that hindered supply of oxygenated blood to the body. Even a little physical exertion would make Mohammed breathless and turn him blue. A simple activity like taking his daily feeds was a task.
Nasir, 30, a salesman at a small store selling mobile phones in Govandi, sold his wife’s gold to raise Rs 60,000 in May last year to list Mohammed for an open-heart surgery at the King Edward Memorial Hospital (KEM) in Parel, the only civic or state-run hospital in Mumbai with expertise in paediatric heart surgeries. Mohammed’s treatment at a private hospital would have cost the family Rs 3 lakh.
The operation was slotted for June 1. But doctors warned Nasir that because of a long waiting list, there could be delays. He was told the department had only two very old, often malfunctioning, heart-lung machines, making it impossible to carry out more than three surgeries a day. A heart-lung machine performs all the functions of a heart when the organ is removed from a patient’s body during an open-heart surgery.
The doctors noted down Nasir’s mobile phone number and said they would call with a confirmed date for the surgery. It turned out to be a long, torturous wait. Every time Mohammed turned breathless or struggled with his feeds, Nasir and his wife, Sakina, 24, would rush him to KEM, begging doctors to operate upon him. Each time, the doctors would treat the boy for a few days, prescribe medicines and send him back with a promise that they would call as soon as a slot for surgery was available.
They never called. Mohammed died on January 14. He collapsed at home after a bout of breathlessness and passed away in his father’s arms on the way to KEM.
Twenty children on KEM’s open-heart surgery waiting list have died since January 1, 2012, while waiting for their turn. On Friday, the waiting list had 700 names, nearly 80 per cent of them children in the age group of one to five. All of them were in urgent need of life-saving operations. And all of them were from families that had no option but to wait because they could not afford private hospitals.
But the queue that is killing little kids isn’t the fallout of KEM being the only public hospital in Mumbai where open-heart surgeries on children can be performed. The queue, in fact, is the result of the municipal corporation’s criminal neglect of the upkeep of hospital’s equipment.
On February 19, Mumbai Mirror reported that one of the two heart-lung machines, which had been used for 29 years – 19 years beyond its best-before date – broke down. The engineers put their hands up. It was beyond repair. The hospital’s Paediatric Cardiac Surgery Department now has only one heart-lung machine and it’s been reserved for emergencies. The term ‘emergency’ could not have a more ironic context than this because almost all of 700 kids on the waiting list need immediate attention, just as Mohammed did.
The Paediatric Cardiac Surgery Department has six surgeons. But they now manage to perform only one or two surgeries a day. With new cases getting added to the waiting list every day, KEM hospital is up against a big crisis. And it could get worse – the one heart-lung machine that the hospital is now left with has been in use for 13 years. It should have been replaced in its 10th year. It has been repaired many times and could breath its last any day now.
The hospital sent a proposal to the BMC to procure a new heart-lung machine way back in 2009. Four years later, the machine is still stuck in BMC’s ill-famed red-tape. Tenders have been called, tenders have been scrapped, and tonnes of documents have been exchanged. But there is no sign of the machine.
“Every time the heart-lung machine broke down, we would remind the officials concerned that it should be replaced. But here we are today, the machine is gone and we don’t have a replacement. I am a professional and it kills me to see these little boys and girls who I know have very little time. If I could, I would operate upon all 700 today. It’s very frustrating,” said a doctor who did not wish to be identified.
Residents of a one-room Slum Redevelopment Authority building in Worli, Sheefa and Azharuddin Ansari’s daughter Ruksar’s name was put on the waiting list in December, 2010. Their first child, Ruksar was just threemonth-old when doctors detected a hole in her heart. The Ansaris were told the girl will have to undergo an urgent corrective surgery. They borrowed money from friends and relatives and deposited Rs 60,000 with KEM.
The family was not given any date for the surgery. They were only told about the long waiting list and that they would get a call when it was their turn. Sheefa would visit the hospital almost every second day to check if a slot for Ruksar was available. She was not going to trust her mobile phone for this, it was a matter of life or death after all. “Sometime there is signal, sometime there isn’t,” she said. On every visit, she received the same response from the hospital – ‘we will call you.’
In July last year, Ruksar took ill. She was breathless and had stopped taking feeds. Doctors said she would have to be operated upon urgently. Sheefa and Azharuddin spent three days at the hospital, waiting for Ruksar to be wheeled into the operation theatre. On the third day, Sheefa was asked to not feed Ruksar because her surgery had been slotted for that day. “At the end of day, I was told some machine was not working and that the surgery will have to be postponed. The next day, Ruksar was discharged from the hospital.” Once again, the Ansaris got the same assurance – we will call you.
A month later, Ruksar died. The end was not very different from Mohammed’s – difficulty in accepting feeds, acute breathlessness, rushed to the hospital, died on the way in her mother’s lap.
In a crude twist of fate, just last week Sheefa received a call from KEM telling her that a slot was available for her daughter’s operation.
The tender floated by the BMC in 2009 for a heart-lung machine for KEM had received two bids – one from the Milan, Italy-based Sorin Group and the other from the Germanyheadquartered Maquet Gentinge Group. It took two years for the entire process of bidding and screening to be completed and Sorin won the bid in 2011.
But there was a problem. In the two years since it applied for the tender, Sorin had moved on to making more advanced machines. Production of the older, less sophisticated, machine that the BMC had ordered had been suspended.
Sorin was willing to give the latest machine without charging a penny more. But the stubborn mandarins of BMC would have none of it. They wanted the machine they had specified in 2009, even if it was an outdated piece of equipment. The tender was cancelled.
A new tender was floated towards the fag end of 2011. Only Sorin bid this time. The municipal corporation waited six months for another bid. When none came about, the tender was cancelled again. Reason? According to BMC’s rules, a tender float is considered invalid if it does not attract at least three bids.
In 2012, another tender was floated. It was scrapped again because only Sorin bid. Yet another tender was issued in the same year. Again, only Sorin bid. Scrapped.
Now, after four years of delays and several children falling to their defective hearts and KEM’s long queue, the corporation has wizened up. A new tender will be issued in March this year and the ‘minimum three bidders’ clause will be dropped. If all goes well, the new machine should be in June-July. But by then, the waiting list for open-heart surgeries would be longer by 500 more names.
Eight-month-old Ayush Verma’s uncle Rajaram Verma brought him to KEM from their hometown Jaunpur in Uttar Pradesh on local doctors’ recommendation. Ayush, Rajaram’s sister’s first born, suffered from pulmonary hypertension, a condition which led to excessive flow of blood into Ayush’s lungs, causing him to frequently come down with coughs and colds. Pneumonia was a constant threat.
Rajaram, his sister and Ayush moved in with their relatives in Dombivili and in August last year the family deposited the money to put the boy’s name in the waiting list. Rajaram travelled every week to Parel to check when Ayush’s surgery could be slotted. On his visits, he would see the hospital’s Paediatric Cardiac Surgery Department overflowing with little children. “After four months of waiting, I grew restless and started checking at other hospitals. I found out that no other government hospital carries out open-heart surgeries on children. Private hospitals told me it would cost upwards of Rs 3 lakh,” said Rajaram.
And then the moment of epiphany arrived on February 12 this year. “I think she had sensed things were slipping out of our hands. Perhaps, we had waited too long. My sister told me that day that she feared she was going to lose her child.”
Rajaram realised it was futile to wait for KEM to give them a date. He decided to sell his land back in Jaunpur and have Ayush’s heart fixed in a private hospital.
But it was too late. Ayush died two days later. “He was struggling to breathe. We rushed him to KEM. They put him on a ventilator. But it was all over in less than three hours – Ayush died even as I and his mother watched helplessly.”
Dr Suhasini Nagda, medical director for all civic-run hospitals, admitted that the situation at KEM is critical. “Yes, there are 700 kids and adults on the waiting list. But the process of buying a new heart-lung machine has been expedited,” she said.
Though she had no answer why it should take a hospital four years to acquire a machine that could save lives of children who are dying just waiting to be treated, Dr Nagda said steps are now being taken to create paediatric surgery departments at other civic hospitals too. “The new tender is for four machines. KEM will get two of them and Sion and Nair hospitals will get one each. We are looking to hire doctors at Sion and Nair for paediatric heart surgeries to shrink the waiting list at KEM,” she said.
Assistant Municipal Commissioner Manisha Mhaiskar said the BMC is doing everything it can to make sure the new heart-lung machines are in within the next three months. “If suppliers don’t bid for this tender, we will acquire the machines directly from them.”
Dr Shivkumar Uttare, executive member of the Maharashtra Medical Council, however, is shocked that the municipal corporation has allowed the situation to reach this critical stage. “Over 700 kids and adults on the waiting list is just unacceptable. With the resources BMC has at its disposal, this should have been dealt with a long time back,” he said. For a department that has 700 families waiting for a call, the size of KEM’s Paediatric Cardiac Surgery unit is tiny. Just five beds, all occupied by women with frail children in their laps. Just imagine their anxiety – they have their children’s surgery slotted after a wait of a year or more. What if they are turned back again, what if the lone, ageing heart-lung machine malfunctions, what if there is a case that requires more urgent attention? Today, the doctors will, if the heartlung machine behaves, operate upon one child – five-year-old Salina Sarfaraz Khan. A resident of Chandrapur in Vidarbha region of Maharashtra, her parents brought her to KEM in early 2010 and her name was put on the list in September the same year. A tense wait of nearly two-and-half years will come to end for Salina parents today. But for Vidya Bhagwat of Akola, whose son, 14-month-old Anup, is 700th on the list, the wait just began last week. Doctors have taken down her number and told her they would call when it’s Anup’s turn.

CHILD’S NAME: Kinnari Golhar PARENTS: Aruna and Gopal Golhar FATHER IS: a salesman in a Yavatmal transport firm WAITING SINCE: April 2011DIED ON: February 8, 2012
CHILD’S NAME: Mohammad Sheikh PARENTS: Sakina and Nasir Sheikh FATHER IS: a salesman at a mobile shop WAITING SINCE: June 2012 DIED ON: January 14, 2013
CHILD’S NAME: Ayush Verma PARENTS: Saroja and Ashish Verma FATHER IS: a farmer in Jaunpur, UP WAITING SINCE: August, 2012 DIED ON:February 14, 2013
CHILD’S NAME: Ruksar PARENTS: Sheefa and Azharuddin Ansari FATHER IS: an AC mechanic WAITING SINCE: December 2010 DIED ON: August 27, 2012



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