Delhi hospitals in the ICU: Shortage of doctors and inadequate infrastructure have crippled healthcare

It’s 2 pm. The Delhi government’s Deen Dayal Upadhyay Hospital (DDU) is teeming with patients, attendants and medical staff. Priya Tiwari has a worried look on her face. She has been sitting in the corridor since 8.30 am. Her wait for medicines for her paralytic mother, Shubhkanti Tiwari, lying next to her in much discomfort, seems never-ending. Earlier, either Priya’s brother or father used to take her mother to the hospital. But they were warned that they would lose their jobs because of the frequent leaves they were taking. “My brother or father would come here twice a week. They would take several hours to go back home. Now I know why. Once, they waited for six hours, only to be told that the MRI scanner was not working,” says Priya, who has been taking care of the household since her mother fell ill.

The scene is no different at most other Delhi government hospitals that see a huge rush in their Out-Patient Departments (OPDs), with thousands of patients lined up for treatment. The DDU receives over 5,000 patients on an average in its OPD every day and this leads to overcrowding. The Central government’s All India Institute of Medical Sciences (AIIMS) has 10,000 patients every day, who throng the gates of the hospital from as early as 4 am.

Delhi Health Minister Satyendra Jain directed medical superintendents of all city hospitals on October 9 to increase consultation time from four hours to six hours. He had said, “This is to ensure that there is sufficient time for the patients to be attended to. Towards achieving the above, the registration counters shall open at 7.30 am and close at 1 pm.”

While the timings may have increased, thousands still suffer every day as hospitals face an acute shortage of doctors. Most exits have been triggered by fat salaries and better work environment offered by the private sector. The AIIMS is short of 863 doctors, including 241 faculty members, 458 senior resident doctors and 164 junior resident doctors. Across the street, Safdarjung Hospital has a shortage of 423 doctors. The number for Ram Manohar Lohia (RML) Hospital and Lady Hardinge Medical College (LHMC) is 157 and 152, respectively.

Most doctors, who stay on, are forced to strike work every now and then, which further leads to long waiting hours for patients. About 300 resident doctors at the DDU went on a strike recently, demanding better security, after two doctors from the paediatric ward were assaulted by a patient’s attendants. This was the second instance in October and third this year of doctors from the hospital striking. The latest strike led to the cancellation of more than 30 surgeries, and patients had to move to other hospitals. In August, over 1,500 resident doctors at Safdarjung Hospital, a Central government facility, struck work over a similar reason, calling off surgeries and disrupting patient care affecting over 300 patients.  Doctors at the AIIMS have also been protesting, demanding the implementations of the 7th Pay Commission, since Diwali.

All 2,700 workers of the Delhi State Health Mission have been on a strike for six weeks, demanding regularisation of their service and pay at par with their counterparts in other departments, paralysing healthcare at the grassroots level. Doctors, pharmacists, nurses, Auxiliary Nurse Midwives (ANMs) and lab technicians in all 11 programmes, including reproductive child health (for reduction of infant, child and maternal mortality rates), tuberculosis, leprosy and integrated disease surveillance (to monitor trends and detect and respond to outbreaks) have stopped work.  

“There has been no recruitment of senior or junior resident doctors in any Delhi government hospital in the past five years, but the number of patients and the work have increased manifold. With an added workload because of polyclinics and mohalla clinics (neighbourhood health centres), doctors have to devote their time everywhere, leading to chaos and increased rush in OPDs. This is a result of bad planning,” says Dr Vivek Chouksey, President, Federation of Resident Doctors’ Association that works for the welfare of resident doctors across India.

The government also started a scheme in 2012, under which patients from economically weaker sections (EWS) are to be given free treatment at private hospitals in Delhi. Each hospital has to reserve 10 per cent beds and 25 per cent of their OPD capacity for EWS patients. Chouksey says this is poor planning because the government is giving hundreds of crores of rupees to private hospitals to cater to a small number of patients. Had the money been used for the development of government hospitals, the situation would have been much better, he says.

DDU Medical Superintendent Dr A K Mehta says, “We have 148 security guards for our wards, but we need another 70 to control the movement of people within the hospital. Everyone comes and waits outside the doctors’ rooms, leading to chaos. Attendants are becoming aggressive by the day and doctors bear the brunt. We have floated a tender to get more guards and equipment to improve the situation.”

Resident doctors at the Safdarjung hospital were given 100 security guards after their strike. The number now is 660, while the hospital needs 2,200 guards.

Mohammad Iqbal (30), a driver, has been visiting the AIIMS and the Delhi government’s Lal Bahadur Shastri Hospital for over a year. His wife, Zeenat Khatoon (26), is suffering from gallbladder stones. Her surgery has been scheduled for April 2018. Their three-year-old daughter, Saima Parveen, suffers from epilepsy. Twice a week, Iqbal takes off from work to bring them to the hospital.

“I leave home at 4 am to reach the AIIMS’ OPD by 5.30 am. The registration opens at 7.30 am. There are card queues before entry. Then stamping happens followed by other formalities. By the time we have seen the doctor, it is already 2-3 pm,” says Iqbal, who has visited the AIIMS seven times this month.

“I do not bother trying to take free medicines from the hospital as the queues are long. I buy them from outside. But I have been taking many leaves from work and that scares me because I am the only earning member of the family.”

Delhi attracts patients from across the country, as the government has not been able to improve healthcare in towns and villages. Many patients from Uttar Pradesh and Bihar visit the national Capital for treatment. Hospitals in these states lack infrastructure. At any given time, hundreds of outstation patients can be seen waiting at the gates of AIIMS or Safdarjung Hospital. Even the AIIMS Metro station is crowded with attendants who sleep on the floor.

Instead of addressing the issues, Union Minister of State for Health Ashwini Choubey said earlier this month that he has instructed the AIIMS Director to send back Bihari patients crowding the hospital with minor ailments which can be treated back home. This created a controversy after which an AIIMS doctor wrote an open letter to him calling his remarks “morally incorrect”. In his letter, Dr Shah Alam Khan, Professor, AIIMS Orthopaedic Centre, mentioned that overcrowding in hospitals is due to poor healthcare infrastructure in the country. He agreed that there is a “loss of gate-keeping” in referrals, but said it is not the patients’ fault and they should not be punished.

“We receive at least 5,000 patients in our OPD every day and over 1,000 in the emergency department. These numbers have increased lately after the government announced free medicines and tests for everyone. A lot of patients from adjacent areas and states are coming to Delhi to avail of the benefits. This has overburdened the doctors,” says Dr Ritu Saxena, Deputy Medical Superintendent, Department of Accident and Emergency, Lok Nayak Hospital.

“There is no proper check or filter to refer patients to hospitals. Smaller hospitals within Delhi are also referring patients even for minor treatment, which leads to unwanted rush.”

Last month, the Delhi High Court had directed the city government to take urgent steps for a third-party audit of all public medical institutions under its control. The order said that the audit would be to “point out the deficiencies and shortcomings and suggest remedial measures to ensure availability of clinical, diagnostic and full panoply of medical services that each hospital was designed to cater to.”

The court lamented the shortage of staff at the Janakpuri Super Speciality Hospital and the Rajiv Gandhi Super Speciality Hospital, opining that the same has “led to a woeful situation of the inadequacy of services to the general public”.

The Aam Aadmi Party (AAP) government in the last two years launched many initiatives to solve the crisis. Increasing OPD timings, making radiology tests free and introducing the concept of Mohalla clinics were some of them.

“The ideal way to solve the problem is to think rationally and come out with a scientific solution. The approach must involve the stakeholders as they understand the situation much better than the bureaucrats.  The hospitals, at their level, are putting the best foot forward to manage the crowd and no patient is sent back,” said Dr Sunil Arora, Medical Director, Guru Tegh Bahadur Hospital.

Many hospitals still complain about the shortage of life-saving drugs and essential equipment. The government had formed a Central Procurement Agency (CPA) in 2015 to ease out purchasing processes. For every medicine or equipment, hospitals had to put in a demand through the central agency. The agency, however, did not receive a positive response from hospitals. Sources in various government hospitals alleged that the agency had failed to fulfil the demands. Even the director of the agency was changed twice as the hospitals complained about the unmet demands.

“It was a failed experiment. The CPA is now under the CBI scanner after the audit department smelled a rat in its functioning. All the hospitals are now making their own purchases,” said a senior official from Delhi government’s health department.

CHOKED HEALTHCARE

• On any given day, hospitals in Delhi are teeming with patients. Safdarjung on October 26 received 8,475 patients in its OPD; 622 new admissions and 110 deliveries were conducted.
   
• Ram Manohar Lohia Hospital on October 26 received 7,865 patients in its OPD; 202 new admissions and 698 casualties.
   
• AIIMS on an average receives about 10,000 patients in its OPD every day. Major surgeries or lab tests are booked for the next six months for all major departments.
   
• Even hospitals like Sucheta Kriplani Hospital and Kalawati Hospitals, associated with Lady Hardinge Medical College, received 3,000 and 1,000 patients in their OPD respectively.