Ratlam: June 10 was a terrible day for us. My nephew, niece and daughter-in-law were injured in a bus accident in Dudh Talai, near the village of Nipania. We frantically dialed 108 for an ambulance, but none were available. A few hours later, we finally managed to hire a private vehicle for Rs5,000 and took them to Ratlam. But my niece Maya Bai (26) died from excessive bleeding,” says Badrilal, a resident of the village of Palasia, who collapses while recounting his family’s horrific ordeal.
Appalling health centers with inadequate testing facilities, drug shortages and non-existent ambulance services plague many villages in Ratlam district of Madhya Pradesh.
Four accidents per week, zero paramedical assistance
The Lebad-Nayagaon four-lane national highway has become an accident prone area due to high traffic density as rail connectivity to Indore, Ujjain, Ratlam, Jaora and other parts of northern Madhya Pradesh has been affected by the pandemic. There are three to four highway accidents every week; yet there is no arrangement to transport the injured to nearby Primary Health Centers (PHCs). In most situations, they are referred to the district hospital.
To the misery of the accident victims is added the distance of nearly 15 to 50 km between the ambulance services and the health centres. For example, the ambulances are 30 km from the Kalukheda PHC, 25 km from the Birmaval and Berda PHCs and 35 km from the Bajna Community Health Center (CHC).
Recently Ratlam Chief Medical Officer Dr Prabhakar Nanaware wrote to the Mission Director of the National Health Mission in Bhopal to take positive action.
Inadequate facilities, lack of qualified medical personnel
Kharwa Kalan village CSC, built with an exorbitant budget, lacks even the most basic facilities. This center is the only government hospital nearby, and residents of 25 villages and dhanis depend on it for all their health needs. However, there is neither a doctor to hold the sanctioned position nor a competent testing center here. Ironically, although an ambulance was purchased through the MLA fund, a driver and diesel fuel were turned down due to lack of funds. There is also no X-ray or ultrasound machine here.
Kharwa Kalan, a shorter route to Indore and other towns, sees more traffic than average leading to more road accidents. The CHC, however, is only equipped to provide first aid as there are no intensive care wards for critically ill patients. The hospital also has a solar panel worth around Rs 40 lakh for electricity, 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 requested. For the ambulance procured from the MLA fund , driver and diesel were not arranged due to lack of budget.We have ordered the transfer of seven such ambulances from 108 call centers to Kharwakalan,” says Dr Nanaware.
The CSP in Birmawal village, about 40 km from Ratlam district headquarters, was recently upgraded from a six-bed hospital to a CSC. A separate building is under construction near the existing structure. Here, Kiran, a nurse, told 101Reporters: “This CSP has the highest influx of women, who come for antenatal consultations. On average, we see over 500 patients each month. Anemia is a common complaint Iron is given through injections if the hemoglobin level is above 7mg, but if the level is below 7mg, then blood transfusions are required, we have no choice but to refer patients to another health center because we are ill-equipped for such treatments.
“Previously, blood tests were done here at the lab. But after the lab technician was transferred, the test equipment was put away and locked up. A technician from another CSP visits our center every three days and takes samples. Reports take another. It defeats the purpose of an urgent care center because every checkup, test and report has a long waiting period,” the nurse explains.
There are two vacancies for doctors, two for operators and sweepers, and one each for a pharmacist, a pathologist and a Birmawal ward boy. The chief medical officer here, Dr Rohan Kanthed, says a letter had been written to the district headquarters regarding the lack of medical staff and a budget for a driver and diesel for the ambulance. Six doctors have been sanctioned, of which three positions of surgeon, gynecologist and pediatrician are still vacant. There are three junior doctors, two of whom are on contract.
Pregnant women pay the price
Many primary health centers lack ultrasound and diagnostic facilities, leaving women with no choice but to travel 10 to 50 km to district headquarters. Even for prenatal visits, patients are forced to travel back and forth between different health centers.
There are 27 to 30 ultrasound centers in the district, including government and private laboratories. However, there are only three at the government level. One is at Ratlam District Hospital, where ultrasound scans are carried out on 80 to 100 women daily. There is a one-week waiting period as patients from all over the district come here for free scans; private centers charge between Rs 900 and Rs 2,200. The other two public hospitals are in Alot and Jaora, but Alot does not have an ultrasound machine installed and Jaora does not have a radiologist. Therefore, the burden falls on the district hospital.
“With a population of 37,000, the number of anemic women and malnourished children in this region is significantly higher than in other regions. Despite these statistics, there are no competent diagnostic facilities available “says Dr. Mahendra Singh Panwar, Physician, Bilpank Health Centre. “Patients have to travel to Ratlam, 20 km away, for ultrasound. There is also no gynecologist or pediatrician available. and Bilpank, and the reports are not available until he returns.”
For the past 23 years, social worker and Padma Shri award winner Dr. Leela Joshi has worked for the health of tribal women and girls in Ratlam. She organized free camps in the villages for check-ups and treatment.
“Although the problem is widespread throughout Ratlam, women in rural areas are more prone to anemia,” says Dr Joshi. “If they don’t get proper medical attention and care during childbirth, it puts the health of both mother and child at risk. One of the main reasons for the number of malnourished children here is that the Prenatal and postpartum care for mothers is lacking. The situation has not improved without proper ultrasound centers and the absence of gynecologists and pediatricians.”
“The well-to-do somehow manage to get ultrasounds done in private centres, but women of modest means are left to fend for themselves. Sometimes, in the villages, women are offered vials of glucose in case of weakness. This is dangerous, especially during pregnancy, as the likelihood of gestational diabetes increases, affecting the health of the unborn baby.”
Health centers on paper vs reality
A population of 5,000 justifies a health sub-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.
Madhya Pradesh CSCs have a staff of 17, including five doctors, surgeons, paediatricians, gynecologists, anesthesiologists and one medical doctor. However, most health centers do not have the services of a gynecologist, a pediatrician or an anesthesiologist.
Currently, Ratlam has six CSCs Namli, Sailana, Bajna, Piploda, Tal and Kharwa Kalan 24 CSPs and 220 health sub-centres.
At present, hopes rest on the official opening of a CSC in Birmaval. A 30-bed health center is being set up at a cost of around Rs5.74 crore. The responsible minister for Ratlam district, OPS Bhadauria performed the bhoomi pujan on May 17.
(The author is a freelance journalist based in Bhopal and a member of 101Reporters, a pan-India network of local journalists)