The Hindu : Tamil Nadu / Chennai News : Free medical care; but what about quality?

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Tamil Nadu

Tamil Nadu - Chennai

Free medical care; but what about quality?

City Bureau

Deficiency in support services in government hospitals affects the quality of health care, says an audit report

PHOTO: K.V. SRINIVASAN.

MODEL WARD: The pay ward at the gastroenterology department at Stanley Hospital has shown the way in implementing infection control procedures. —

CHENNAI: Free are the services, of course. But are patients really satisfied with the quality of services offered in government hospitals? The treatment is shoddy, cleanliness is given the short shrift and emergency services such as ambulances are inadequate.

The Central government-sponsored performance audit for the year ending March 31, 2007 on the function of teaching hospitals in the State revealed that super-specialty treatments such as heart surgery and kidney transplant were continuously provided only in teaching hospitals in Chennai and Madurai.

Deficiency in support services such as ambulance and steam laundry affected the quality of medical care, the report stated. Funds earmarked for purchase of medicines and equipment were lying with the Tamil Nadu Medical Services Corporation for want of proper monitoring, it said.

Also hundreds of posts such as nursing assistants, administrative officers, laboratory technicians, sanitary workers, sweepers and stretcher bearers, remained vacant.

Responding to the findings, Health Secretary V. K. Subburaj said, “Lots of posts have been filled up and many are yet to be filled. We have rectified most of the defects pointed out by the report.”

A real story

A patient was admitted to Government Stanley Hospital on May 23 after being run over by a lorry. He is still in the hospital with a spinal cord injury and broken hip and says the treatment has been lackadaisical. After intervention from some presspersons, he was shifted to a special ward but even there only after the junior doctors in-charge were admonished by a senior doctor, did treatment improve.

“They periodically take my blood and urine for tests but surgery has still not been performed. Doctors have told me that wounds must heal to avoid infection,” he says.

Like him, thousands of less privileged persons flocking these hospitals for treatment have misgivings about the quality of care.

The sheer number of patients is difficult to deal with, acknowledges Government General Hospital Medical Superintendent V. Palani. Last year the hospital spent around Rs.83 crore, he says.

However, little care has gone into maintenance or setting standards for services. The walls of the newly-opened twin tower blocks sprout black lines of seepage that stretch from the ceiling and trickle down above general ward patients’ heads.

Stanley Hospital, which has outsourced cleaning work, could be much cleaner, patients point out. A patient recalled how the corridors and the men’s ward were quickly cleaned just before Health Minister M.R.K Panneerselvam and Mr. Subburaj inspected the hospital recently.

“Maintenance is the challenge for us,” agrees K. Saraswati, director of Institute of Obstetrics and Gynaecology. Stained cotton wool balls and dirty corridors are the bane of these hospitals.

“Nothing is impossible,” says gastroenterologist R. Surendran whose department in Stanley Hospital has brought down the death rate from 20 to 4 per cent through infection control procedures. His experiment with pay wards was later adopted by the government with a few modifications.

Ambulance service

A young mother in Perambur East maternity centre managed by the Chennai Corporation died in April because there was no ambulance to transfer her to the nearby referral hospital. This incident spurred the civic body to hire private ambulances and float tenders to purchase its own ambulances.

The IOG has five vehicles but only two are on the road and one is for the director. Two are under repair. Stanley Hospital has 10 vehicles, some of which have oxygen tanks and drips. GH officials say they have seven shifting vehicles and two VVIP vehicles.

Only these VVIP vehicles are modern day ambulances equipped with defibrillators, ventilators, medicines and trained paramedical staff for on the spot care. But none of the other ambulances are dispatched to bring in patients from accident sites.

They are instead used for shifting patients from one hospital to another.

Dr. Poongothai, Assistant Professor in the Emergency ward at the GH, says a trained paramedic team to administer first aid could bring an improvement of up to 30 per cent in the condition of trauma patients.

A. Ananda Kannan, Medical Council of India, suggests that patients requiring rehabilitation be transferred to peripheral hospitals.

These were built to decongest the referral hospitals but continue to lack important specialty services, vital diagnostic facilities, medical, paramedical and support staff. Doctors from the referral hospitals could visit them every week and monitor patients, he says.

(With inputs from R. Sujatha, Sarah Hiddleston and Kannal Achuthan)

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