High accident rate, no emergency care: Madhya Pradesh healthcare reels from insufficient facilities

High accident rate, no emergency care: Madhya Pradesh healthcare reels from insufficient facilities

High accident rate, no emergency care: Madhya Pradesh healthcare reels from insufficient facilities

Pregnant women, children and critical accident victims in Ratlam endure substandard health centres that desperately need a facelift.

Ratlam, Madhya Pradesh: "June 10 was a dreadful day for us. My nephew, niece and daughter-in-law were injured in a bus accident at Dudh Talai, near Nipania village. We frantically dialled 108 for an ambulance, but none were available. Hours later, we finally managed to rent a private vehicle for Rs5,000 and took them to Ratlam. But my niece Maya Bai (26) died due to excessive bleeding," says Badrilal, a resident of Palasia village, breaking down as he recounts his family's horrendous ordeal.

Abysmal health centres with inadequate testing facilities, shortage of medicines and non-existent ambulance services are the bane of many villages in the district of Ratlam in Madhya Pradesh.

Four accidents a week, zero paramedic assistance

The Lebad-Nayagaon four-lane national highway became an accident-prone zone due to heavy traffic density, since train connectivity in Indore, Ujjain, Ratlam, Jaora and other parts of northern Madhya Pradesh were affected due to the pandemic. There are three to four accidents on the highway weekly; yet, there's  no arrangement to rush the injured to nearby Primary Health Centres (PHC). In most situations, they are referred to the district hospital.

Piling onto the misery of the accident victims is the near 15km to 50km distance between ambulance services and the healthcare centres. For instance, ambulances are 30km from the Kalukheda PHC, 25km from the Birmaval and Berda PHCs, and 35km from the Bajna Community Health Centre (CHC).

Recently, Chief Medical and Health Officer of Ratlam Dr Prabhakar Nanaware wrote to the mission director of the National Health Mission in Bhopal to take some positive action.  

(Above) A lab in Kharwa Kalan, Ratlam, Madhya Pradesh lies vacant. (Below) The Primary Health Centre (PHC) in Birmawal village, now a Community Health Centre (CHC) has just 6 beds at the moment. 

Inadequate amenities, lack of trained medical personnel

The CHC in Kharwa Kalan village, built on an exorbitant budget, lacks even the most basic facilities. This centre is the only government hospital in the vicinity, and the people of 25 villages and dhanis depend on it for all their health needs. However, there's neither a doctor to take up the sanctioned post nor a competent testing facility here. Ironically, even though an ambulance was procured through the MLA fund, a driver and diesel fuel were denied due to lack of funds. There's no X-ray or ultrasound machine here either.

Kharwa Kalan, a shorter route to Indore and other cities, sees more than average traffic, resulting in more road accidents. The CHC, however, is only equipped to provide first-aid as there are no ICU wards for critically-ill patients. The hospital also has a solar panel worth around Rs40 lakh for electricity purposes, but it remains unused.

"A total of 26 ambulances are approved in Ratlam district. Of these, 11 vehicles are under 108 and 15 vehicles are under Janani Express. Now, 21 more ambulances have been demanded. For the ambulance bought from the MLA fund, a driver and diesel were not arranged due to lack of budget. We've instructed the transfer of seven such ambulances from 108 call centres to Kharwakalan," says Dr Nanaware.

The PHC in Birmawal village, about 40km from the Ratlam district headquarters, which was only a six-bed hospital, was recently upgraded to a CHC. A separate building is under construction near the existing structure. Here, Kiran, a nursing staff, told 101Reporters, "This PHC has the highest inflow of women, who come in for antenatal consultations. On average, we see more than 500 patients every month. Anaemia is a common complaint. Iron is administered through injections if the haemoglobin level is above 7mg. But if the levels are below 7mg, then blood transfusions are required. We have no choice but to refer the patients to another health centre as we are ill-equipped for such treatments."

"Earlier, the blood tests were done here in the lab. But after the lab technician was transferred, the testing equipment was put away and locked up. A technician from another PHC visits our centre every three days and takes samples. The reports take another three days. This defeats the purpose of an emergency healthcare centre, as every check-up, test and report has a long waiting period," the nurse explains the state of affairs. 

There are two vacant posts for doctors, two for operators and sweepers, and one each for a pharmacist, pathologist and ward boy Birmawal. The medical officer here, Dr Rohan Kanthed, says that a letter had been written to the district headquarters regarding the shortage of medical staff and a budget for a driver and diesel for the ambulance. Six doctors were sanctioned, of whom three posts for a surgeon, gynaecologist and paediatrician are still vacant. There are three junior doctors, of whom two are on contract.  

(Above) The way to restrooms for Dharad Primary Health Centre (PHC) is loaded with garbage and dirt. (Below) Ambulances without diesel and a driver stand's outside the Kharwa Kalan CHC. (Below) Birmaval has now been upgraded to CHC, a new building is being constructed for CHC in the hospital premises.

Pregnant women bear the brunt

Many PHCs do not have sonography and diagnostic facilities, leaving women with no choice but to travel 10km to 50km to the district headquarters. Even for prenatal check-ups, patients are forced to travel back and forth to different health centres.

There are 27 to 30 sonography centres in the district, including at government and private labs. However, there are only three at the government level. One is in the district hospital at Ratlam, where ultrasounds are conducted daily on 80 to 100 women. There's a waiting period of a week since patients from across the district come here for scans performed free of charge; private centres charge between Rs900 to Rs2,200. The other two government hospitals are in Alot and Jaora, but Alot has no ultrasound machine installed, and Jaora has no radiologist. Therefore, the burden falls on the district hospital.

"With a population of 37,000, the number of anaemic women and malnourished children in this region is markedly higher than in other areas. Despite these statistics, there are no competent diagnostic facilities available," says Dr Mahendra Singh Panwar, Medical Officer, Bilpank Health Center. "Patients must go to Ratlam, 20km away, for an ultrasound. There's also no gynaecologist or paediatrician available. The lab technician comes to the Dharad, Namli, Birmaval and Bilpank PHCs thrice a week, and the reports are available only when he returns."

For the past 23 years, social worker and Padma Shri awardee Dr Leela Joshi has worked for the health of tribal women and girls in Ratlam. She has organised free camps in villages for health checkups and treatment. 

"Although the problem is prevalent in the whole of Ratlam, women from rural areas are more prone to anaemia," says Dr Joshi. "If they are not given proper medical attention and care during delivery, it puts the health of both the mother and child at risk. One of the main reasons for the number of malnourished children here is that prenatal and postpartum care for mothers is lacking. The situation hasn't improved without proper sonography centres and the absence of gynaecologists and paediatricians."

"The affluent somehow find a way to get an ultrasound at private centres, but women of lower means are left to fend for themselves. Sometimes, in villages, women are offered glucose bottles for weakness. This is dangerous, especially during pregnancy, because the likelihood of gestational diabetes increases, affecting the unborn baby's health."

Birmaval is on its way to upgrade the original PHC into a CHC

Health centres on paper vs reality

A population of 5,000 warrants a sub-health centre. However, in the tribal belt, the limit is 3,000. The government opens PHCs for a population of 20,000 to 30,000, while CHCs are sanctioned for a population of 80,000 to 1.2 lakh.

CHCs in Madhya Pradesh have a staff section of 17 members, including five doctors, surgeons, paediatricians, gynaecologists, anaesthesiologists and a medical officer. Yet, most healthcare centres do not have the services of a gynaecologist, paediatrician or anaesthesiologist.  

Currently, Ratlam has six CHCs — Namli, Sailana, Bajna, Piploda, Tal and Kharwa Kalan — 24 PHCs and 220 sub-health centres.

At present, hopes rest on the formal opening of a CHC in Birmaval. A 30-bed health centre is being set up at the cost of about Rs5.74 crore. Ratlam District Incharge Minister OPS Bhadauria performed the bhoomi pujan on May 17.

Edited by Grace Jayanthi


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