Working in India: Studying government hospitals in rural Rajasthan and Jharkhand, India

Updated February 10, 2011 with Jharkhand details

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Gurgaon Railway Station is in the old part of the city One of the better potholed roads of rural India Goats pretend to have right of way on the way to Malpura Government hospital in Deoli, Rajasthan Dining area in Rajmahal Palace Hotel, Rajasthan, India Minor operation theater in Malpura Government Hospital Delivery table in Deoli Government Hospital, Deoli, Rajasthan, India Temperature controlled baby cot in Deoli Government Hospital, Deoli, Rajasthan, India The general ward, Deoli Government Hospital, Deoli, Rajasthan, India Ambulance without any medical facilities, Deoli, Rajasthan, India 108 Ambulance with medical facilities, Deoli, Rajasthan, India Segregated bins for medical waste, Rajasthan, India

The Job

My first project at Deloitte India started a few weeks after moving to Gurgaon. The team is working with an international donor organization and the Government of India to assess public hospitals across 4 impoverished Indian states. Our job is to understand the current state of affairs and implement targeted improvements over 2 years.

The Team

The Team: Cr. Chaavi, Meenal Bagla, Fauzia, Ashwin in Bisalpur Dam in RajasthanPHOTO: (left to right) Dr. Chhavi, Meenal Bagla, Fauzia, Ashwin. All about 30 years of age. As the subject matter expert on the team, Chhavi assesses the core medical stuff. As the only guy on the team, Ashwin doubles as a team member and a deterrent to eve-teasers.

The Trips


Part I – Rajasthan

The Commute

6 a.m.

Gurgaon Railway Station is in the old part of the cityPHOTO: Waiting at the Gurgaon station for our ‘high speed’ train to Jaipur. The sun wasn’t out and the cab’s neon stereo belted out popular Bollywood songs throughout the bumpy ride to the station. The train ride to Jaipur took 4.5 hours, where we started the next leg of the commute – the cab ride to the village.

12 p.m.

An overloaded truck collecting leaves for cookingGoats pretend to have right of way on the way to MalpuraOne of the better potholed roads of rural India
PHOTOS: An overloaded truck collecting leaves for cooking, goats pretend to have right of way, one of the better potholed roads of rural India. We rode on roads that were usually much worse for 3 hours to reach the Government Hospital.

3 p.m.

Government hospital in Deoli, RajasthanPHOTO: Public hospital in Deoli, Rajasthan. The hospital at Malpura was similar. Both the hospitals are delivering more babies than before after a federal program started paying pregnant women  Rs.1600 ($35) for delivering their babies in an institution instead of their home.

9 p.m.

Dining area in Rajmahal Palace Hotel, Rajasthan, IndiaPHOTO: We stayed in a ‘haveli’ in Rajmahal, an old Indian palatial house, that had been converted into a hotel. Using Rajmahal as our base, we commuted to each of the two hospitals in Malpura (2.5 hours) and Deoli (30 minutes).

The Work

We assessed 2 public hospitals in Rajasthan for their maternal and child health services. India’s maternal and infant mortality rate is very high and the government has started to focus on making 24×7 delivery services, c-sec, obstetric complications capabilities, neonatal units etc. available at most public hospitals.

Infant mortality rate
India: 55 deaths per 1000 live births
USA: 6.3 per 1000 live births

Maternal mortality rate
India = 254 deaths per 100,000
USA = 8 deaths per 100,000

Infrastructure and facilities

Both the hospitals that we visited are in the villages of Rajasthan and cater to 250,000 people each. The services and facilities are very basic by city standards but still impressive for rural India – a labor room for conducting deliveries, an operation theater, a few wards for pre-operative and post-operative patients, a laboratory, an x-ray room, and an outpatient area.

Medical personnel

At each hospital, doctors are on call 24×7 since there is only 1 specialist of each kind – 1 pediatrician, 1 Ob/Gyn, 1 surgeon etc. Both day and night duties are handled by the same doctors and nurses. In addition to their core medical duties at the hospital, both doctors and nurses are required by the government to perform field work such as community health education, blood camps, immunization camps, sterilization camps etc. This adds to their work load and almost every doctor and nurse at both hospitals complained about it.

Minor operation theater in Malpura Government HospitalPHOTO: Minor operation theater (O.T.) in Malpura. This is currently being used for conducting all surgeries, including those that would typically be conducted in a major O.T. (e.g. c-sections) after the primary OT’s roof collapsed several months ago.

Delivery table in Deoli Government Hospital, Deoli, Rajasthan, India PHOTO: A delivery table in Deoli Government Hospital. Rubber mats are used during deliveries to collect and channel the waste into the trash can. These mats are meant to be washed and reused to keep costs down.

Temperature controlled baby cot in Deoli Government Hospital, Deoli, Rajasthan, IndiaPHOTO: A baby cot in Deoli Government Hospital. Cots are usually temperature controlled using radiant warmers. This cot used a home grown solution since it was missing a radiant warmer.

The general ward, Deoli Government Hospital, Deoli, Rajasthan, IndiaPHOTO: The general ward is used for both males and females in Deoli Government Hospital. Malpura has 50 beds, while Deoli has 33 beds.

Ambulance without any medical facilities, Deoli, Rajasthan, IndiaPHOTO: Both the hospitals have an ambulance, although the vehicle itself has no medical supplies or equipment. It can accommodate one patient and a few family members and a paramedic is almost never present. The ambulance is essentially a means of transportation. Private traffic doesn’t obey right of way rules, so expect it to drive as fast/slow as every other car.

108 Ambulance with medical facilities, Deoli, Rajasthan, IndiaPHOTO: The state provides a public emergency service called 108 free of cost (similar to 911 in the U.S.) but I didn’t get a chance to look inside. The hospital staff claimed that it contains all the medicines and equipment required for handling emergencies.

Segregated bins for medical waste, Rajasthan, IndiaPHOTO: Segregated waste in 4 color coded bins. The hospitals have non-medical staff for cleaning, laundry, record keeping, and general maintenance. Kamla, an uneducated ward woman responsible for general cleanliness, has been trained on waste segregation and removes biomedical waste from the delivery room and the O.T.


Part II – Jharkhand

The heart of corrupt and Naxalite India

I visited two hospitals in the remote areas of Jharkhand – one in Daltonganj and another in Gumla. There were no hotels/guesthouses/motels in either town for more than $8 per night, so we commuted everyday from Ranchi – the corrupt state’s capital. The commute to Gumla was about 2 hours each way. Daltonganj was more painful at 3.5 – 4 hours each way from Ranchi. Traveling on Jharkhand roads, especially in the forested areas, was NOT recommended after dark since it was Naxalite territory and prone to bomb violence.

Gumla District hospital entrance, Jharkhand, IndiaPHOTO: District hospital in Gumla, Jharkhand

The structure and services in both the hospitals in Jharkhand were similar to the ones in Rajasthan. However, the vibe of corruption permeated Jharkhand hospitals compared to Rajasthan. For example, the financial statements in both facilities in Jharkhand showed plenty of funds but the doctors constantly complained of a shortage of funds. The sweeper was paid Rs. Y per month but the yearly expense for cleaning was Y x 12 x 2. It wasn’t clear why the yearly expense was 2 times of the expected amount.

Unused mobile health unit, District hospital in Jharkhand, IndiaPHOTO: Nepotism and politics was also on full display. At one of the facilities, the local politician had donated this impressive mobile health van over a year ago. The van stood proudly at the hospital entrance but it had never been used! The hospital claimed that there was no budget to hire a driver. Like other things, the financial statements suggested that money wasn’t a problem.

The other facility owned a treadmill, an ECG machine, an ultrasound, etc. Painfully, there was no cardiologist or radiologist at the facility and none of these expensive machines had ever been used. When asked why they were bought in the first place, I was told in a hushed tone that the purchases were “lucrative” for the procurers.


Part III – How the experience changed me

I used to think that public hospitals in India were callous places where patients were neglected while doctors sipped tea. Clearly, this image was not grounded in any fact or experience. During this trip, I saw doctors and nurses make every effort to provide basic care to patients despite uncomfortable working conditions and poor infrastructure. If our team is able to implement improvements over the next 2 years, it will directly affect the care provided to hundreds of thousands of people. That would be pretty special.

Comments

2 local comments so far.
  1. Arun gautam,

    this is the real face of a sub medical facility center in rajasthan. I 

  2. Arun,

    What a wonderful update, Meenal. You are right, the scale of impact is just astonishing in India. Looking forward to the Jharkand update. Cheers! Arun

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