Govt clinics not in pink of health

Govt clinics not in pink of health
Preetu Nair and Rajtilak Naik, TNN

PANAJI: On the face of it, Goa has excellent health facilities. Nineteen primary health centres (PHC) and more on the planning board. This
includes a 10-bed PHC at Chinchinim and 40-bed PHCs at Bali, Canacona, Quepem and Sanquelim. Even the doctor-population ratio of 1:636 appears excellent when compared to the 1:2148 in the rest of the country.

Indicators, however, can be misleading and the ground reality far different.

A check by TOI exposed the bitter truth -- the PHCs are short staffed, equipment like X-ray machines are available but there are no technicians to man them, operation theatres lie unused as there is no surgeon or anaesthetist and instead of serving a maximum of 30,000 people, in Goa the PHCs serve a population anywhere between 20,000 and 85,000.

Goa Medical Council member Dr Shekhar Salkar says, "Doctors at PHCs are not trained to handle emergencies. Also, there is a shortage of manpower and equipment to tackle emergencies. There is an urgent need to appoint more doctors and add equipment at the PHCs rather than focus on constructing new buildings."

Check this out: If residents of Sanquelim and Candolim are fortunate to have a doctor 24x7, this has been at the cost of residents of Surla in Pale and Keri and Guleli in Sattari, as the doctor from there has been temporarily posted at Sanquelim PHC. Similarly a doctor from the Pernem community health centre has been temporarily posted at Candolim PHC to tide over the tourism season rush.

On public demand, a new health centre was opened at Ribandar, but no doctor posted, and a doctor from Panaji is deputed to attend to patients there.

With 13 PHCs having just one doctor on night duty, patients are immediately transferred to the district hospitals or to the GMC. In most cases, in the absence of attendants, it is the security guard and the patient's relatives who struggle to lift patients from stretchers to the ambulance.

While health care is concentrated in and around Panaji, Margao, Vasco and Mapusa, rural Goa has been overlooked. It is, therefore, not surprising that rural patients still rush to Goa medical college and hospital even for minor ailments like coughs, colds and diarrhoea.

Dr Rajan Kuncolienkar, GMC medical superintendent explains this saying, "People find the facilities at the GMC better and have faith in the treatment provided there rather than at the PHC. Due to this there is huge rush at GMC."

Admitting that Goa's health indicators are heavily urban centric leading to the belief that everything is fine, Dr Gladstone D'Costa, president, Voluntary Health Association of Goa said, "Some of the PHCs are badly maintained and lack basic facilities like water and electricity 24x7. Very few PHCs can handle an emergency situation, either due to a lack of amenities, facilities or due to inadequate medical staff."

A patient, vomiting and complaining of chest pain, and rushed to Bicholim PHC at 1 am last Sunday was immediately transferred to Asilo hospital, Mapusa instead of the Valpoi community health centre, as it does not have enough staff. He was shifted in a DHS ambulance, but a patient from Betki PHC would have to wait for the 108 service ambulance as the DHS ambulance at this PHC has not been working for the last three months.

If PHCs are the cornerstone of rural health services -- a first port of call to a qualified government doctor in rural areas -- then about 3 lakh people living in the vicinity of a PHC are denied night-time care as there is no doctor on duty.

Loutolim, Cortalim, Colvale, Corlim, Chinchinim and Quepem PHCs have no doctor on duty at night. Interestingly, all six PHCs have a security officers guarding the premises at night.

Further, when the doctor at Loutolim PHC was asked to attend the National Family Health Survey meet at Panaji, last Friday, patients had to return home or seek the services of a private doctor as there was no doctor available at the PHC.

Of the 19 PHCs in the state, six PHCs don't have a doctor 24x7. Health services director, Dr Rajnanda Dessai said, "Only 13 PHCs work 24x7, while six others are daughter' PHCs and have no admission facilities. Therefore there is no doctor at night in these PHCs."

This, despite the Indian Public Health Standards (IPHS) of the directorate general of health services, ministry of health and family welfare as part of the national rural health mission stating that the minimum requirements (assured services) at PHCs, which cover a population of 30,000 should be, "4-6 indoor or observation beds and OPD services for four hours in the morning and two hours in the afternoon or evening". It also states that PHCs should provide "24 hours emergency services and in-patient services with 6 beds".

However, PHCs in Goa cover a population between 21,000 and 83,000. "The load on the PHCs has increased over the years, but the number of doctors posted at them has either remained steady or declined. Though doctors have been absorbed on contract basis, it is a temporary solution as most of this is urban centric," said former Indian Medical Association, Goa branch president Dr Francisco Colaco.

Sources revealed that more than 30 posts of doctors and technicians in community health centres are still vacant. However, Dr Dessai maintained that the PHCs cater to routine cases. "The focus here is on the first line of treatment. Moreover, the staff position is as per norms prescribed and when a post falls vacant, we try to fill it on a priority basis."

22 Jan 2009, The Times of India, Goa edition