Is Nagpur Living up to Its Identity as a Medical Hub?

I am writing this article from a private room of a private hospital in Nagpur.

Nagpur, situated at the centre of India, serves as a medical hub for people from Madhya Pradesh, Jharkhand and Chattisgarh. The city is characterised by the booming demand for healthcare services and their subsequent supply. There is not a single doctor, clinic, nursing home or private hospital that does not have patients representing this country’s economic disparity, social diversity and common desire to live a long and healthy life.

The room is 12ft x 15 ft with a small toilet attached to it. There is a TV, cupboard and AC along with a narrow padded bench for the patient’s attendant. There are 5 such rooms on the floor, some house a single patient, others two. There is a PICU and ICU opposite to these rooms. A nursing station takes care of the patients in the rooms. The nursing station is manned by nurses and a Resident Medical Officer (RMO), a Post Graduate in Ayurveda.

Caste System in Hospitals?

I have had the opportunity to visit other such hospitals and have observed six categories of staff to care for admitted patients. There are allopathic doctors who have specialised in a particular stream of medicine; the RMOs who are ayurveds; the nurses, who probably do not hold degrees in nursing yet administer medicines prescribed by the allopathic doctors; the moushis who clean the ward, make the bed, provide bed pans and bathe female patients; the ward boys, who cater to male patients and transport patients between departments. And then there are the janitors who clean the toilets.

There is a division of labour that has less to do with expertise, skill and experience and more to do with nature of the work. In the wards, neither the specialists nor the RMOs attach a urine bag to the patient, nurses do not clean the patient nor do they attach urine bags to male patients. This is done by the wardboys or the male nurses if any.

I have been witness to an incident where a retired armed forces officer, admitted in a private hospital, was forced to urinate on his bed because the doctor and the nurses were trying to find a wardboy to attach a urine bag instead of doing it themselves.

This form of division of labour is perpetuated with impunity because it’s a win-win for the hospitals that pay their staff poorly, while providing a facade of respectability for their work that no one else will do.

Isn’t this an extension of the caste system? This structure endangers the life of the patient and puts a lot of responsibility on the shoulders of those who are not trained for such tasks. Further, as this is considered low level work not much training and thought is given.

Employing ayurveds in hospitals practicing western medicine puts the life of the patient in jeopardy. The difference between ayurveda and allopathy is as good as chalk and cheese. The dangers of this were apparent to me today when the ayurved RMO was reading out the molecules of Taxim-O, an allopathic medicine, over the phone to an allopathic doctor to clear doubts on dosage that a patient had.

Where’s the Infrastructure?

Nagpur is full of doctors who are fellows of reputed foreign medical institutions. They have trained and practiced abroad and consulted at foreign hospitals. However, the standards that are demanded at these foreign hospitals are not adhered to in their practice at home. Private hospitals are not well ventilated, are potential fire hazards because of single exits and exposed wiring, and lack facilities for those accompanying the sick.

To maximise building space, these hospitals do not provide parking space which leads to traffic congestion. The only people suitably skilled and experienced to carry out their job are the doctors trained in allopathy. One could say that these places are an ode to the endearing spirit of jugaad. Other cities are also riddled with similar problems.

Which brings us to the question ‘are hospitals mere service providers or healthcare providers in its truest sense?’

For healthcare to be thorough there needs to be a certain level of service. This service includes hygiene, training of staff, provision of wards and rooms that are consistent with giving patients the best chance for a speedy recovery. The ethics of the practice of allopathy is a no-brainer and therefore is not being mentioned as part of service.

The issue here is that people do not know what to expect from these hospitals. They are so in awe of the medical profession that they remain silent to the treatment that is meted out to them. Patients are only influenced by the doctors ability to treat and not by the ancillary facilities that ensure their treatment is successful. Are hospitals taking advantage of this predicament facing the patient?

What Qualifies as a Hospital?

Hospitals in India are supposed to be guided by the Indian Standards for Basic Requirements for Hospital Planning, the Clinical Establishment Act besides other regulations and standards. They are also supposed to get sanctions for their building from the municipality. Besides, there are over 20 certificates/permits that are needed for the setting up of hospitals. Bodies like the National Accreditation Board for Hospitals and Healthcare Providers (NABH) accredit hospitals. However, as per the NABH there are only 480 hospitals in India that are accredited with it. There is an arbitrariness in how healthcare is delivered in India. Therefore does it not beg the need for basic standards for the provision of healthcare which is enforceable?

It would be prudent to say that a standardisation exercise ought to be carried out by a third party with inputs from the Indian Medical Association (IMA). This institutionalisation of ‘duty of care’ needs to include everything from safety and building design to appropriate qualifications for staff and their training, to adherence to the Biomedical Waste Management and Handling Rules. Once the standards have been agreed to and are in place, an independent body should carry out planned and unplanned audits at regular intervals.

There are many dichotomies that define India, the one in healthcare is unfortunate. While India is being sold as a medical tourism destination, its healthcare system takes the everyday Indian for granted. Duty of care does not begin and end with the expertise of the doctor. It has to incorporate the satellite operations that facilitate the treatment of the patient. This will only happen if there is uniformity in practice and it will go a long way in treating the sick.

(Samir Nazareth is the author of ‘1400 Bananas, 76 Towns & 1 Million People.’ He tweets at @samirwrites)

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