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City hospitals catch a cold

They are the city’s landmark hospitals. But most are plagued by problems of limited funds, lack of space or staff, equipment problems and at times even red-tapism.

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They are the city’s landmark hospitals — some of the best in the country. But most are plagued by problems of limited funds, lack of space or staff, equipment problems and at times even red-tapism. Deepa Suryanarayan checks the vital signs of some of Mumbai’s biggest hospitals

At 11.30pm on Sunday night, Ashish Pujara, who was preparing for his nightly bath, slipped in the bathroom at his Mazagaon residence and was rushed to the nearest hospital, JJ Hospital. But little did he know of the ordeal that was to follow.  “There were no technicians available to man the machines at that hour. After an hour of running around, they told me I would have to wait till the next morning for an X-Ray,” says Pujara. “I was in too much pain, and decided to go to a private hospital, where I managed to get treatment,” he added.

At Sion Hospital, one of the biggest trauma centres in the country, the only seven-year-old ultrasound sonography (USG) machine in the radiology department has been partly functioning since March 31.

Patients like Omprakash Mishra and Atiq Ansari, who wanted to undergo a Doppler ultrasound test as a diagnostic procedure, were asked to wait for three months. Following complaints from patients and media reports, the hospital was finally sanctioned new USG machines. According to a social worker at JJ Hospital, patients are given sonography appointments at the hospital only after 15 to 20 days. At KEM Hospital, which is well known for its orthopedic expertise, the situation is no different.

Though the hospital has a huge budgetary allocation to procure the best and latest equipment, an out-patient (one who is not admitted to the hospital) would have to wait for at least two months to get an MRI report. And so Santosh Gawade, a patient who came to KEM, expressly for treatment for a neurological disorder diagnosed in his hometown Sholapur, has been waiting at the hospital for over 15 days to get his diagnostic tests done. “We are given dates for the tests. The doctor told me it would not be possible to get it done earlier as there are too many people waiting to get the same test done,” says Gawade.

Government hospitals provide about 23 per cent of the total 40,000 hospital beds in the city. As per WHO norms for provision are 1/550 population per bed, the ratio for Mumbai works out to about 1/3,000.

KEM hospital, for instance, has a bed capacity of 1,800. There are 1.5 lakh annual admissions to the casualty ward and 15.5 lakh out patients every year. Indoor admission is in the vicinity of about 85,000, while 65,000 operations are performed per year.

KEM sees about 5,000 patients every day. “But we get ten times that number of relatives and visitors. So there is a floating population of about one lakh people in the hospital premises at any given point of time, which naturally leads sot overcrowding,” explained Dr Neelima Kshirsagar, Dean, KEM Hospital.

The hospitals, on their part, cite various reasons, from over-crowding and the huge influx of patients they see on a daily basis, to lack of funds and even internal disputes for this lapse. There is also an acute need for trained technicians in all the hospitals. Most of the equipment at the hospitals is overused because of the large number of patients coming to them. “When this sensitive equipment is used by inadequately trained staff, it results in a break down,” explains a technician at Sion Hospital.

X-ray units at Sion and KEM, for instance, are closed on Sunday and operate for half a day on Saturday. This, claim Resident Medical Officers (RMO) at KEM Hospital, is because skilled technicians are less in number and the RMOs are themselves not skilled enough to handle it.

Another problem at most hospitals is corruption. “Funds were secured for the morgue freezer at JJ Hospital. But the freezers are yet to come. Meanwhile, another requisition has already been sent to the state,” says a source.

JJ Hospital

One of the biggest hospitals in the state, the 1,300-bed JJ Hospital is ill-managed and ill-equipped, say patients. Due to its sheer size and location, the hospital sees a lot of patients referred from other hospitals across the city and even the state. Adding to the already existing crowd is the huge number of patients referred to the other city hospitals that function under the aegis of JJ Hospital, like GT, St George and Cama & Albless Hospital.

Despite overcrowding, according to sources, there is no lack of equipment or facilities at JJ Hospital. “There is so much high-end equipment at the hospital, but sadly, it is not being used. The surplus equipment alone could suffice for another full-fledged hospital,” says a source at the hospital.

There is an acute lack of co-ordination in the administration system, which is worsened by the internal politics in departments, add sources. Red-tapism exists, not at the higher level, but at the clerical level, where paper work takes the most amount of time, say sources. For instance, renovation work in the Orthopedic Operation Theatre (OT) has been going on for over one year, much to the inconvenience of patients who come to the hospital.

However, the good news is that the hospital has for the first time begun entering all its medical records on computers. This is expected to be completed by October 2007. “Computerisation will ensure that there will be a central agency coordinating with all departments,” says a departmental head.  “There is an acute shortage of ventilators. JJ has five ventilators in the ICU, and two in the emergency ward, out of which one is not functioning currently. Doctors have to temporarily remove ventilators from another patient, in case a very serious patient comes to the hospital,” says a social worker at the hospital.

  • X-Ray machines: 11; all in working condition, being used routinely. Three more machines are expected in the coming months
  • CT Scan machine: 1; used round the clock
  • MRI machine: 1; use is limited to certain hours and certain days. According to sources, it is non-functional most of the time.
  • Ventilators: 5 in the ICU; at least five more needed.
  • Sonography machine: 1 in the gynaecology department and 2 in the radiology department

Sion Hospital

Sion Hospital has a bed capacity of 1,422. The annual figure of patients treated here is eight lakh, while out-patient attendance is up to 10 lakh. In-door admission is 55,000 to 60,000 per year, with about 35,000 to 45,000 operations being performed per year.

With this kind of patient traffic, there is a huge load on medical equipment, machines, as well as medical and para-medical staff.

With round-the-clock admissions of patients, sources say that a few departments, particularly, trauma, medicine, general surgery and orthopedic simply cannot cater to the large number of patients. “The number of patients waiting to be admitted into these wards always outnumbers the existing bed facilities,” says a source from the hospital.

The hospital has just one CT Scan machine which is used round the clock and is soon expected to procure a MRI machine. “This has been long overdue. Currently, if an MRI test has to be done, the patient is directed to go to KEM hospital,” says a doctor, seeking anonymity.

Another problem area for the hospital is lack of ventilators. “There are a couple of ventilators. However, considering the number of patients we cater to, they are not enough,” added the doctor.

According to sources, there are several posts - including those for senior doctors - that have been lying vacant for a very long time. “We have vacancies at various levels in the staff structure. They aren’t being filled due to several reasons. If they are filled up, the functioning of the hospital can be improved and the workload on the current staff can be reduced,” says a source from the hospital.

  • X-Ray: 4
  • CT Scan machine: 1; fully functional machine, used during the day.
  • MRI machine: To be procured soon. Currently, patients are referred to KEM hospital.
  • Ventilators: 7

Sonography machine: 5 machines in the gynaecology department which is fully functional. There is one machine in the Radiology department which is currently not functional.

KEM Hospital

The hospital faces a combination of problems, from overcrowding to lack of skilled technicians and improper allocation of funds to the right departments.

Most departments at the hospital are over crowded. However the Radiology department, Medicine department and the Surgery ward are the most affected, say sources.

In the X-Ray department, for instance, the ten working machines are used round the clock. They are manned by 60 technicians who work in eight hour shifts. However, each X-Ray requires a technician, an attendant and an assistant. And the entire staff takes Sunday off and works for only half a day on Saturday. “If a person wants to get an X-Ray done on the weekend, it is not possible,” says an RMO. The same goes for sonography department as well.

While CT scan and MRI machines too work round the clock, the problem here is the sheer number of people wanting the tests done. While an in-door patient (who is admitted to the hospital) could get the test done in a maximum of three days, an outdoor patient would get an appointment two later for a CT scan and an MRI would take up to three months, even though about 25 MRI scans are conducted every day at the hospital, using the single MRI machine available.

There is a lot of renovation work going on at the hospital, and a budget of Rs400 crore has been allocated for it. However, all the funds are used for the old building which is renovated every two to three years. “Most decisions are only on paper,” says a source.

  • X-Ray machine: 10 machines; fully functional; are used 24x7
  • CT Scan machine: 2 fully functional machine; used 24 hours a day
  • MRI machine: 1; machine, fully functional, more than 25 MRIs are conducted in a day
  • Ventilators: 55 (approximately)
  • Sonography machine: 6; to seven machines, all are working

Nair Hospital

The hospital with its 250-odd senior staff members and 400 resident doctors take care of more than one lakh patients every year through the outpatient departments.

The total number of admissions in a year exceeds 37,000. Authorities at the hospital agree that there is a shortage of technical staff at the hospital. However, they have received a budgetary allocation to hire staff.

Sources at the hospital say that even though there is room to improve facilities, when compared to other government hospitals, Nair Hospital is the best equipped.

“But, there is no MRI facility. So patients are referred to JJ and other hospitals,” said an RMO. The CT scan machine, though over-burdened, is fully functional and seldom breaks down. As the hospital has portable X-Ray machines, X-Raying patients is not a problem, says a staff in the radiology department. The hospital is well equipped with ventilators, however, but since they are in great demand, they are often unavailable for patients.

  • X-Ray machine: 6 portable machines and three plants in the main department, fully functional
  • CT Scan machine: 1 fully functional machine; used 24 hours a day
  • MRI machine: No machine
  • Ventilators: Approximately 35; all except three are functioning
  • Sonography machine: 2 machines; fully functioning

Inputs from Poornima Swaminathan

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