Eventually, it was loss to the community

by iphindia | Dec 13, 2013 | Blog

This is a story about a Primary Health Center (PHC) and a lady doctor. An ordinary centre in the way so many of our health centers in remote parts of the country are. This unremarkable PHC is located 52 km away from the district head quarters (HQ) and 36 km away from the taluk HQ. In Tumkur district of Karnataka. It is connected with poor roads and scarce public and private transportation. The PHC’s area of responsibility has 10,811 inhabitants distributed over 23 villages. The sex ratio is 976 female 1000 males and most people are engaged locally in agriculture while a few go to work in the district headquarter (HQ). The main agricultural products are paddy, ragi, coconut and arekanut. Local panchayat and sangaha members have good political influence at taluk and district level. And the villages are under strong political influences. The elected panchayat officials are no way supportive to the conduct or functioning of the PHC. But they are capable of putting pressure on government departments through their counterparts at the district level. This pressure tactics can lead to transfer or suspension of officials.

The PHC in our story has suffered due to lack of human resources since 2011, no doctor since 2 months, the ANM post lies vacant since the last 9 months, the pharmacist post since last six years, and alas…… two group ‘D’ posts are unfilled since four to five years.

The Medical Officer is by convention a doctor, so the post lay vacant in the PHC for two to three months. Meanwhile, a doctor working in a PHC in the neighboring district, who was born and brought up in Tumkur applied for this post in her home town. Apparently, she succeeded and got the transfer.

This new MO was disciplined, committed, and strict and self motivated. A good clinician, concerned about quality health care, she had experience in bringing about minor and major changes while staying in the HQ in her earlier PHC. Hence she joined this PHC and expecting to implement many changes.

As an initial step, she introduced a Token System for the Out patients department (OPD). Every day the centre sees 90 to 100 outpatients and it was difficult manage the crowd and provide quality service to each one. Her intention was that using tokens, patients should be able to consult a doctor with EASE COMFORT and PRIVACY. The system allowed the MO to give enough time for each patient, adequate for their needs. Eventually, when patients come out from the consultation room; they should have experienced the satisfaction of treatment.

Since many years, the PHC had not been reporting its information independently– it was reporting to the nearby PHC. The new MO wrote a letter to the Taluk Health Officer (THO) urging that the information be sent directly to him. He accepted, and with greater efficiency of team time, the information system was streamlined.

She made provision for all lab test materials to the PHC’s lab technician, thus precluding pregnant women going for ANC checkups to neighboring health facilities. She started visiting villages and anganwadis for regular health checkups and attending community level meetings. On one such visit, along with us, she observed that two to three open water tanks are providing the drinking water sources for villagers and may cause damage through infected water. She wanted to protect the water tanks, and sent a written complaint to the Gram Panchayat but no action was taken on it. She asked us if any NGOs were working on water and sanitation, wanting to co-operate in order to protect those water tanks so that villagers could drink safe water.

Along with these major changes, MO made some minor changes in the PHC, such as implementing the digital display of the information education communication (IEC) board. This board is where all patients can watch and learn about various national programmes. Earlier, the District Health Society (DHS) had distributed computers to all PHCs in the district but due to the erratic electricity supply to the PHC, the earlier MO had not brought the computer to the PHC. The computer lay unused in the THO office. Our new MO got the uninterruptedpower supply (UPS) device repaired and negotiated with THO about getting the computer back to the PHC. In conclusion, the computer reached its destination in working order. The MO also wanted to bring the PHC 24X7 working status; when deliveries could be conducted in the PHC avoiding much travel and hardship for pregnant women during labour.

While clearly she was trying to make some changes with existing resources, she was also facing many hurdles from some community members.

One day, a local Sangha related to ‘Kannada Rakshana Sangha’ (Karnataka Protection Sangha) thought to set up an idol on the occasion of Ganesh Festival, and they went to ask MO for contribution money. She refused to contribute money for the festival. One of the same sangha members, with political influence shouted at the MO, making allegations that she was taking money informally from the patients and using that money for car fuel. “And you denied to contribute the money for Ganesh festival “they shouted, but the MO ignored all this. But this man who shouted at the MO could not sit quiet; he went on to make a complaint against the MO to the DHO office. He reached the DHO office with one more person who was politically influential at the district level and lodged a complaint against the MO. They forced the DHO to issue a notice letter to MO. The DHO probably unaware of the ground reality combined with political pressure issued a notice latter based on the allegation made by the sangha member. The MO replied to the notice saying that she would not use the car from district head quarters…… and started using public transportation to reach the PHC.

Similar to this, one more incident happened in a different situation and on a different day in the PHC. As I mentioned earlier, the MO was so strict and disciplined that it was mandatory that all patients should take a token if they wanted to consult a doctor. Once, local political leader, knowing of this token system followed in the PHC, made direct entry to OPD consultation room. The MO did not recognize him and asked him to come in line with his token, but he shouted at her saying “I am a political leader belongs to XXX party and you should give the priority to us!” Unafraid, she denied his demand and asked him to come in line with the token. Embarrassed and wanted to take the revenge on the MO at a later time, when opportunities come; he kept all these things in the mind and went back.

One day, a patient with severe chest pain visited to the PHC around 10 am. Inopportunely, MO was on leave on that particular day and it was informed to THO over the phone. When patient reached the PHC, nobody was there, except group‘d’, non-medical staff. This staff called the 108 ambulance to transport the patient, but by the time the ambulance reached the PHC, unfortunately the patient died.

It appears that people who were angry with the MO for other reasons now got an opportunity to act. They went to a community member, succeeded in gathering several people and called for action against the MO. They succeeded in getting a higher authority to issue a suspension letter. The THO and DHO both visited the PHC to control and convince the crowd about the incident but they were unsuccessful in convincing the crowd. The crowd remained unmoved insisting that the District Commissioner (DC) come to the spot and the suspension order against the MO not be revoked… Eventually, the DC did come and tried to convince them about the circumstances around the death of the patient with chest pain. He did not succeed and finally issued a 3 month suspension letter to the MO with the consent of THO and DHO.

As a researcher who has spent two years in the taluk., I would like to state this…

A self motivated doctor tried to make some changes in a remote PHC in Karnataka using the minimal available sources and succeeded to some degree with no external and internal support in the system. Her attempt was to ensure that quality health care services were equally available to all, including the poor. She ended up travelling up and down 52 (one side) km in public transportation in order to prove a point. Eventually, the MO becomes a victim in a power-battle, and ultimately the community has lost good doctor in their PHC. The tail of the story is happier- the department revoked her suspension order and the MO has rejoined to department in another PHC, 10 km away from the district HQ, with good public and private transportation.

Bheemaray V M