When Bimala Majhi, 30, of Dongriguda village in the remote Nawrangpur district of Odisha went into labour, she had to be rushed to the only Public Health Centre (PHC) in the area located at Jharigoan. To reach there, the heavily pregnant woman had to endure a long and arduous journey – first she travelled 10 kilometres to Badtemra village in a bamboo basket carried by her husband, Dhanapati, and two nephews; it took them 45 minutes to cover that distance. From there she went another 36 kilometres by bus.
By the time she reached the poorly-equipped Jharigoan PHC, she had developed severe complications and was referred to the subdivision hospital at Umerkot, about 11 kilometres away. An autorickshaw was hired, but when the family reached Umerkot they found that the only doctor there was on leave. So Bimala had to be taken to the district hospital at Nawrangpur, where she underwent a caesarean operation and gave birth to a baby girl who died after a day. For any mother, the loss of a child is tragic. But when this tragedy is replayed, many times every day, it provokes the question: Where is the health care for the people who need it most? Says a dejected Dhanpati, Bimala’s husband, “Our village is completely inaccessible. Every year, people are dying because accessing any form of health care in these parts is difficult. And even if there is a health centre in the area, it is often of little use.”
In 2004, when Dongriguda and Jharigaon had made it to the front pages of newspapers because 12 children had died of malnutrition and lack of time medical care, the state government promised to look into improving its health services. Yet, when after seven years, a case like Bimla’s surfaces with alarming regularity.
Ironically, it’s not like there is no health infrastructure in place in the tribal-dominated and Maoist-violence affected Nawrangpur district. On paper at least, it has 37 PHCs and seven community health centres (CHCs) covering 10 blocks. But what use is a mere building when there is no one in it to attend to the multitudes of the sick?
Here’s how alarming the personnel shortage is: At the district headquarters hospital, on which more than three lakh people are dependent, there are 10 positions lying vacant, including key posts in the Departments of Medicine, Orthopedics, Paediatrics, Obstetrics and Gynaecology, Eye, Skin, Anesthesia, Pathology and Surgery. If you thought this was bad, here’s what the situation is like at the PHCs: While 36 posts of surgeons are vacant currently, in the last decade no doctors have been posted in the 11 specialist departments. At least 20 sub-divisional hospitals in the district are being run by health workers and nurses, while some facilities in very remote areas are being managed by Class Four employees, who have never received any professional medical training. No doctor has ever been posted at PHCs near the villages of Kosagumuda, Papadahandi, Dabugam, Jharigam, Chandahandi, Nandahandi and Tentulikhunti, while in the seven CHCs in Nawrangpur senior medical officers’ posts have been lying vacant for the last 12 years.
Says Kusuma Gauda, 50, of Chandahandi village, “No doctor has been sighted here. The Chandahandi PHC is run by a pharmacist. During times when malaria and diarrhoea occurs, a mobile doctor unit comes by. But they usually stick around only for a day. For the rest of the year we are mostly dependent on the medicines given by our local village ‘vaidya’. We have no alternative.”
Dependence on the local medicine men or those selling indigenous therapies is not uncommon. Poverty has as much to do with this – very few can afford to go to the big Berhampur Medical College and Hospital in Ganjam district or to hospitals in Visakhpatnam in the neighbouring state of Andhra Pradesh – as does the lack of personnel at the existing facilities.
Topography, too, contributes to the poor access. Nawrangpur is hilly and has only fair weather roads. During the monsoons, people have to walk or at best ride cycle. This situation is particularly trying for pregnant women. Sushama Jain, a local activist who works for Jagruti NGO explains, “In Nawrangpur, which has one of the highest Infant Mortality Rates in Orissa, women nearing their delivery date have to sometimes travel 50 to 60 kilometres to the district hospital through terrain that can be crossed only on foot and could even entail crossing rivers. No other modes of transportation exist here.”
Just as in Bimala’s case, it’s usually the hospital at the district headquarters that comes to the rescue, because the PHCs simply can’t handle an emergency. “After reaching the PHC if there is some added risk, then the personnel there will not even touch these patients. They are immediately referred to the district hospital,” Jain adds.
These delays are only contributing to the rising graph of maternal deaths, mostly of women from the tribal community. The figure for deaths among infants below five years, too, is dismal – it remains at nearly 90 for every 1,000 children (Source: Comptech Tribal Rehabilitation Society, an NGO that has done a survey on IMR in the district). Several tribal women prefer to deliver babies in their homes, instead of trudging for hours to congested hospitals, where they anyway are not likely to receive any specialist care. For the last one year there has been no gynaecologist posted anywhere in the district.
Ultimately it comes down to a lack of good doctors and trained medical support staff. Dr Manoj Parida, the in-charge doctor at the Umerkot Zonal Hospital, admits to this scarcity, “Besides a lack of infrastructure, in this hospital out of nine posts of doctors only three, that includes me, are filled. Four posts have been vacant during my entire tenure of six years. We don’t have even an anaesthetist here so how can we conduct major operations? Whenever we come across a serious patient we have no option but to refer them to the district headquarters hospital.”
Dr J.K. Behera, former Chief District Medical Officer of Nawrangpur district hospital, explains the reasons that have brought the entire system to its knees, “This is one of the most backward and underdeveloped tribal districts with a lack of proper connectivity and educational facilities. So most of the doctors who are posted here are not willing to stay on. Moreover, over last few years there has been an increase in Maoist activities in the district and the situation is only getting worse. Fearing for their life in places like Kundei, Raighr, Jharigram and Umerkot, doctors are not ready to work.”
Under fire from activists as well as the Opposition, the Navin Patnaik government had claimed that by 2012, the healthcare service will reach the doorstep of people in Orissa. But good intentions need to be backed by some serious effort.
