The recent media story about a ward boy who stitched up the wound and administered an injection to an accident victim in Uttar Pradesh seems to have evoked a passionate response from the media and some sections of the public across the country. Most doctors would be more amused than surprised to see the public indignation at what, on the face of it, was an unqualified person doing the job of a doctor.
Talk to any doctor who has worked in government (and many private) hospitals anywhere in India and you will come to know that what happened was pretty much Standard Operating Procedure. In many States, ward boys and OT assistants suture superficial wounds, give IM injections and routinely apply splints/POP casts in the case of fractures and other injuries. The experienced operation theatre staff nurses often guide the rookie gynaecologist in performing the Caesarean sections and hysterectomies. It is not at all uncommon for a senior staff nurse to gently inform the young gynaecologist that she is perilously close to severing a vital vessel or structure. OT assistants and ward boys often apply dressings and bandages with as much efficiency as orthopaedicians or surgeons though many of them have no formal training.
In most hospitals across India, the ward boys and OT attendants have been trained on the job in assisting the doctor with these tasks. Should they have been allowed to be trained on this is a moot point but one must look at it in the context of the desperate situation hospitals in many parts of India find themselves in. There are crippling staff shortages both of doctors and nurses in most States and these paramedical staff fulfil a vital need as in many cases the qualified personnel are not available.
To put things in perspective, the country faces a nursing staff shortage of between 40% and 50%. The Report of the Parliamentary Standing Committee on Healthcare tabled in late April this year noted that in the All-India Institute of Medical Sciences in New Delhi there were 1,468 vacant posts. This included over 350 vacancies for doctors, including 47 for professors.
Within hours of the Bulandshahr episode making its way to national television, the media went into a frenzy. The next day, there was a report on how a CMO's driver in Kushinagar was attending to patients, how a sweeper was suturing a wound in Ballia district and so on.
The damage that such news reports can cause is enormous. The next time there is an emergency case and the doctor is busy with another patient they will leave this patient alone even though they can potentially be cared for by the “trained on the job” attendant. This will lead to patients bleeding and perhaps even dying because the MO dare not ask or allow the attendant to work on the patient for fear of the hidden camera.
The attitude of the U.P. doctors was a refreshing change. Without trying to be defensive they merely stated that there had been no breach of protocol and that what the camera caught was not unusual. This seemed to stir our media hacks even more.” Would the ward boy have done the suturing if the patient was the son of a minister,” asked one channel? Of course, not. But don’t we live in and accept a system where our netas and babus and the rich are much more equal than the rest of us in all fields? So why should healthcare be different?
The larger question that emerges is whether we should be training our paramedical staff in such tasks routinely so that the quality of their work can improve. There are a handful of precautions that need to be taught for giving an IM injection or doing a superficial suturing and these can be taught in a week. So if a doctor has assessed the patient and recommended these kinds of procedures are required, it should be possible to assign these tasks to the attendants quite safely. In U.P. there are reportedly 4,200 doctor posts that remain unfilled and there is a 42% deficiency of nursing staff. So what do our media angels suggest? Letting patients bleed to death?
(The writer, a Consultant in Internal Medicine, can be reached at sumanthraman @vsnl.com)