Chaos and confusion all over. The staff are rushing and running around with palpitation and panic. The pounding of their hearts and raised blood pressure are not easily felt, but sweating can be seen by the hapless relatives and well-wishers of the critically wounded or ill lying inside the casualty.
The wailing of patients can be heard. Their agony doubles as their dear and near ones are not around. The white-attired gods are too busy to listen to or console them or explain what the crisis is. Instead, they shout at and curse the onlookers coming in their way as a means of letting off steam.
Is it not a regular scene in casualty rooms in most of the district hospitals in the country?
District hospitals are the apex of tertiary care in many districts of north, central and eastern India. And their casualty is a place where poor people rush in for specialist service when it is a life-and-death condition. They do not have medical colleges or superspeciality hospitals. The patient without money or influence has only a government hospital to turn to. A lot more needs to be done.
A little bit of imaginative thinking and allocation of extra resources with deep commitment to save more lives can change the scenario in the porticos of many government district hospitals. Access to the casualty itself is not very clear even in the daytime, leave alone at night, without any glow sign or display boards to the public or a driver who may be a stranger to the town.
Limiting access to the casualty front door further are the haphazardly parked rickshaws, bicycles, motorbikes, tractors, jeeps and cars of patients and visitors. I saw an elevated cemented slab of a huge sump tank for drinking water right in front of the casualty entrance of a district hospital. So every patient has to be carried in arms by relatives, or by helpers on payment of ‘bakshish,’ to the emergency room if that patient cannot walk to the doctor’s chamber. It requires only a little bit of tapering or levelling of edges with cement to make the ambulance/wheelchair slide over it.
Once I challenged an ambulance driver to get the vehicle out of the covered shed in less than 15 minutes which he could not do as the pathway in front was fully blocked by haphazardly parked vehicles.
High steps, sharp corners with narrow corridors or wide verandas but doors too narrow to turn around trolleys or wheelchairs are revealing examples of the arrogant and uncooperative PWD engineer who supervised the construction long ago or a lethargic medical superintendant who refused to make any change in spite of some young casualty medical officers and staff nurse demanding minor modifications.
It is a good practice to display the name and the mobile number of the duty doctor, nurse, ambulance driver, lab and blood bank technician and specialist on call for emergency communication and recall. When there is no display of the duty roster and no responsibility is fixed, everybody will think someone else will do the job and the result is nobody is doing anything. Emergency room is the last place it should happen.
Inadequate and non-functioning equipment and supplies demoralise the staff who want to work but who become helpless and ineffective, cutting a sorry figure in front of the distressed bystanders. At times, the lack of an opening spanner denies the dying patient vital oxygen and the lack of a working plug point renders the suction apparatus unfit for clearing secretion from a choked patient.
Lack of emergency medicines or poor replenishment of stocks is almost criminal in a casualty room. Poor stacking or storing of life-saving medicines without proper labelling and display denies timely access to them in an emergency.
It was embarrassing to the casualty medical officer and nurse in one of the district hospitals in central India, when I asked them at a drill to get an adrenalin injection loaded immediately for an anaphylactic shock. After five minutes, they found the staff who had the key of the almirah where the plastic container was kept and, after a further five minutes, upon opening the container, realised that the life-saving injection was out of stock. The last vial was used a fortnight ago and nobody replaced it!
Unlike in a medical college where residents of different speciality are easily available, the district hospital does not have the luxury of specialists attending on every case immediately. Casualty duty is in rotation by different doctors of different specialities, e.g., an eye specialist managing an asthma case. A good display of algorithms of most essential steps in different types of emergency under different systems will make case management easier. Such simple steps will save more lives and lessen miseries and avoid altercations in casualty rooms. Is there anybody listening out there?
A welcome sign are the preparations for ISO and NABH certification that have opened the eyes of many in this direction.
(The writer is a former Health & Nutrition Specialist for UNICEF and former Director, State Health Resource Centre, Chhattisgarh. Email: krantony53 @gmail.com)
