Outlook English - Print Subscribers Copy Outlook English, 02 July 2018 | Page 15

APOORVA SALKADE
Maharashtra
THE BROKEN
SYSTEM THAT
KILLS THE KIDS
VITAL LINK Cottage Hospital, Jawhar taluka, Palghar
A journey through three links in
the hinterland’s healthcare chain
Cottage (or Kutir) Hospital in Jawhar, a taluka of Palghar
district, things are worse. This hilly terrain is good only for
marginal farming; economic migration is rampant. Of the 1.5
lakh population here, 90 per cent are adivasis and 80 per cent
live in villages. Children under six are 16.6 per cent of the
by Neel Shah in Nashik
demographic. Cottage was set up in 1947 by the last raja of
Jawhar with just 10 beds—upgraded to 30 when it was trans-
SMAIL Sheikh’s baby, born at just 24 weeks, is in Nashik Civil
ferred to Bombay state in 1948.
Hospital. The tempo driver from Dhule is anxious—he knows
As many patients at Nashik Civil are from this region,
tragedy had befallen 187 babies here last year. “I felt my child
Cottage could have been a vital link in the healthcare chain.
may not survive if I admit her here, but had no choice,” he says.
Instead, the situation is grim at the taluka’s only big hospital,
Tabrez Sheikh, an NGO worker who helped Ismail with the
which caters, in turn, to people further upcountry—Mokhada,
form­alities, says everyone in this neck of the woods is ber­eft of
Wada, Vikramgad etc. “Our 100 beds always have over 200
choice. “Patients from Palghar, Kasara, Dhule, Jalgaon, Ahmed-
patients,” says a nurse, and a doctor gloomily adds: “During
nagar, Jawhar, Mokhada and Thane seek treatment here,” he
monsoons, it’s one bed for three patients.”
says. Those place-names range across a varied social map: urban
The sole incubator—essential for premature newborns or
and distinctly rural (and adivasi) Maharashtra. There’s a snap-
those with birth defects, low birth weight or other condi-
shot here of three layers of healthcare, progressively thinning
tions—“is working most of the time”, and, as Cottage has 36
as one loops outward. Nashik Civil is the nucleus. It has added
baby warmers, but no ICU, “during emergencies, we recom-
equipment and filled vacant posts since last year’s tragedy.
mend patients to Nashik Civil,” the doctor says.
“Our infant mortality rate is half compared to last year,” says
The gaps leap out at you. Specialists are missing—a paedia-
Dr G.M. Holey, additional civil surgeon. High base, but still.
trician but no paediatric surgeon, a sonograph machine but no
Every month, some 250 babies are admitted here and
doctor or operator. A private doctor with his own sonograph
another 1,500 outpatients land up too. There are 541 beds,
tests patients at Rs 500. Three of 14 doctors never report to
275 nurses and just 12 doctors, who perform all but heart and
work. Of the 15,000 litres of water it needs, the municipality
brain surgeries. The Sick Newborn Care Unit has 32 nurses,
provides only 2,800. The hospital buys water at Rs 350 per 5,000
and seven posts are vacant. Troubling, because nurses can
litres, but not clean water—that it cannot afford.
be as critical as doctors in childcare. “The posts will be filled
There’s no major operation theatre here, nor a blood bank. Only
soon,” says senior nurse S.V. Patil.
66 of 94 sanctioned doctor and nurse posts are occupied. But
The hospital has 36 incubators, twice the number in 2017.
there are three generators. “Despite load-shedding, we have no
“But there are still no ventilators,” says Holey. If this crucial
power problem,” says an office superintendent.
element in emergency life support is missing, it adds to
The last link in this chain is the primary health centre in
the systemic weaknesses. Remember, patients show up at
Jamser, 8 km away. “We have installed 10
district hospitals as rural areas are already
beds, though we are a six-bed setup,” says
devoid of healthcare infrastructure.
Specialists at CHC, 2016
Dr Kiran Patil, who believes every district
When such weak systems inevitably
requires a multi-specialty hospital. Even
crumble—as they did in Gorakhpur, Calcutta,
Shortfall (%)
Required
1,440
PHCs, which are meant to deal with minor
Odisha and Kolar—doctors can do little but
65
In position 505
illnesses, pregnancies and so on, need to
cite “late arrivals, infections and extreme
be upgraded. Right now, they cannot even
malnourishment” as key causes of death. As
Shortfall of male health workers
handle deliveries—the panic only rises each
Holey says, “The hospital alone cannot be
at sub-centres 2,471
time cases are forwarded to Jawhar and
held responsible.”
IMR in Maharashtra: 19
from there to Nashik. Often too late. O
Three hours from Nashik, at Patangshah
I
Source: Rural Health Statistics, SRS
2 July 2018 OUTLOOK 15