Scene one: A month ago, a 55-year-old woman was rushed to the casualty of the Government Medical College Hospital, Thiruvananthapuram, with severe head injuries sustained in a road accident. The doctors wanted to put her on ventilator before they could begin any procedure to save her. However, none of the hospital departments had a machine to spare. The woman’s family called up everyone they could think of to get a ventilator.
Finally, after a call to the Health Minister’s office, a ventilator was made available in the neurosurgery intensive care unit (ICU). A nurse and one of the patient’s relatives pushed her, in that critical state, on a trolley from the critical-care ICU on the ground floor of the old outpatient block, two floors up through a narrow ramp — the lift was not functioning — through the corridor which connects the old block to the neurosurgery ICU in the super-specialty block.
Scene two: On World Heart Day, a specialist doctor in a private hospital called up a prominent cardiologist in a major private hospital in the city to seek his advice for chest pain. The cardiologist could not see him then, but asked him to take an ECG and consult him in the evening. Nothing showed up in the ECG. The doctor went to consult the cardiologist in the evening, but collapsed and died in the consulting room.
The woman, sadly, died of injuries on the third day.
“We have friends and acquaintances who are fairly well-connected and can get things done in the hospital. Yet, the agony in those few hours till we secured a ventilator is beyond words. She didn’t die because of lack of medical care, but I am sure, every day, hundreds of ordinary people’s requirements for emergency medical care are being severely compromised by the total lack of resources and planning in the hospital,” says a friend of her family’s.
The unlucky doctor’s old classmates working in the hospital swear that he could have been saved, if instead of waiting to see the cardiologist, he had just come to its casualty wing where his condition would have been assessed and he put under observation and given care.
“It is chaotic at best, on any given day or time, in the casualty. The ambience is not very hospitable; you may not be received well; you may find the dressing rooms in a mess of bloodied cotton swabs; and you may end up carting your patient yourself because nursing attendants are few… there is definitely a lot of room for improvement but every patient is given due medical care,” a senior faculty member of the medical college says.
Mind-boggling stats
The casualty attends to between 600 patients and 1,000 patients a day. In the past two weeks, the number of patients was close to 8,500. During the period, nearly 40,000 patients were handled at the outpatient clinics of 23 departments (excluding figures of Sree Avittom Tirunal Hospital). Every patient is accompanied by at least two or three helpers.
The number of patients in the casualty and outpatient and inpatient clinics and their helpers on any day should be a law-and-order nightmare anywhere else.
“It is a miracle that this hospital continues to function despite the limited money, manpower and infrastructure at our disposal, given the sheer volume of patients we are expected to cater to. It is not the deficiency of medical expertise or the lack of service which is affecting the quality of care; the bane of this institution is a combination of bad civil engineering, poor planning and tedious administrative processes,” sources in hospital administration told The Hindu.
Inhospitable
In any service industry, people make all the difference. It is the lack of people with a cooperative attitude to receive the patients, to guide them and their helpers through the behemoth of a hospital and trained attendants to move patients from one place to another that makes this hospital one of the most inhospitable places to be, during a medical emergency.
Its old main block housing the casualty wing is a maze of dark corridors, stairs and ramps.
Imagine yourself, a distressed first-time visitor, trying to find your way to the CT scan room through this maze, pushing your critically injured friend on a trolley. Only two or three attendants will be on duty at a time, and they would be engaged with some other critically ill patient. Not enough trolleys or wheelchairs are there either.
“To move a trauma patient from the casualty wing located in the southwest part of the old main block to the emergency CT scan room on the northeast side, takes some ingenuity. One has to take the lift from the casualty one floor up, go through a seemingly unending corridor by medicine wards 1 and 3; again take the lift to reach the CT scan room.
The time lost in taking the trauma patient for the scan and back to casualty is significant and unfortunately, it can affect the outcome,” a doctor says. “The excellent service provided by the doctors here goes unappreciated in the chaos created by the ill-maintained system and poor planning.
The renovation and redesigning of the casualty should have taken precedence over any other development work on the campus — nowhere in the world would a trauma patient being rushed to the emergency wing need to cross four bumps before reaching the hospital entrance.
There has never been a scientific assessment of our requirement of essential equipment such as ventilators in proportion to the volume of road traffic accidents we are catering to,” a senior doctor says.
A green channel system, which allows the admission of an emergency case to the department concerned that actually provides the required specialised care, is what is needed at the casualty, instead of the tedious admission system at present. Quality of care provided, especially in key emergencies such as heart attack or head injuries, will improve significantly without any additional expenditure, if this system is followed.
