'What can we do if funds don't reach us': Palghar doctors live in dread

A discarded ambulance at primary health centre in Palghar. Pics/Hanif Patel

The gut-wrenching story of a deaf-mute woman from Palghar who died after being made to run from one hospital to another for a C-section delivery last week was among a handful of tales that trickle out of the tribal belt. But for doctors posted in the district, poor infrastructure, inadequate manpower, snakes and government apathy are a way of life. Doctors now dread the visit by a special team that will assess fund utilisation. The medical fraternity in Palghar fears a crackdown as a 15-member team, appointed by Vidhan Sabha, is on a three-day inspection to cross-check the use of government funds.

mid-day spoke to dozens of medical officers of Primary Health Centres (PHCs). "But what we can do if the funds do not reach us. Now, the committee will submit their report to the government. Later, MOs [medical officers] will be called to Mantralaya to explain. This is nothing but harassment. On one end, you are not providing us with basic requirement yet you expect us to perform to match world-class facilities," said a medical officer of a Palghar PHC.

The inspection team that will be checking the use of funds in Palghar

"Snakebite cases are rampant here and victims have to travel in their own-arranged vehicle because the ambulance is lying dysfunctional for years. But if a child or woman dies of snakebite, it becomes a loud cry in Mantralya," said another MO. According to government data, low birth weight, prematurity, birth asphyxia, pneumonia, diarrhoea, hypothermia, asthma, meningitis, septicaemia and congenital heart disease are behind high death rates in the district.

Palghar saw the death of 565 children in 2015 due to these health reasons, while 557 kids died in 2016. From 2017 to 2021, the deaths stood at 469, 348, 303, 296 and 294, respectively. Up to March this year, 63 kids have died due to reasons including unknown bite/snakebites (16). The district has had 92 maternal deaths since 2016. Sources said these numbers reveal only those who died during treatment in Palghar. "There are many victims who were rushed to adjacent districts for immediate medical attention but if they died there, naturally their data will not be included in this," said a source.

‘Unlivable quarters'

No doctors or nursing staff members are available at the PHCs and it is one of the prime reasons that pregnant women or children don't get immediate attention at these facilities.

A medical officer said, "On-duty doctors as well as nurses are wiling to stay on PHC premises if the government quarters are maintained. Why and how anyone will choose to stay in a government quarter if it is a house of snakes? Rat menace is another issue… we have seen venomous snakes sneaking into the chambers of toilets."

A primary health centre in Vasai taluka of Palghar district

"Will any one of the committee members dare to stay overnight? The answer will be ‘no', but it will be made an issue that the doctors are not available at PHCs…nobody will bother to know the reasons behind why a doctor is not ready to stay there," said a nursing staff.

Overworked staff

A medical officer that more than half the important seats are vacant in Palghar. "Instead the MOs are given additional charges so that the person concerned can be pulled up in case of a crisis," said the MO. "There is no anaesthetic in Palghar district, the MBBS doctors are handling delivery cases because most of the PHCs are not having gynaecologists. We have to run PHCs with limited sets of medicines. There are many issues that need to be addressed but who listens to us? We can't even protest but we are always arm-twisted if anything goes wrong at the PHC," said another doctor.

Late pay, poor CIBIL score

Delay in salary is among the biggest grouses of the medical staff in the district. "We have to pay rents, school fees, run the house and maintain social status, but there is no salary. Can you imagine how embarrassing it is when the school administration summons us for not paying the fees on time? The landlord asks for the rent every month…but our salaries are always delayed," said a doctor.

"The worst affected months are January to March, and the salaries of these three months are given either in April or sometimes it goes till mid-May…" said the MO. A senior medical officer said that the CIBIL score of most of the MOs are poor because the EMIs are not paid on time. "They can't think of getting loans in future because their CIBIL score has gone for a toss."

No post-mortem at civic hosp

A doctor at a PHC said not a single civic medical officer in the district has conducted a post-mortem since the Vasai-Virar City Municipal Corporation formed a decade ago. "There are civic-run hospitals in Vasai taluka but none of them conducts post-mortems and the burden falls on PHC. The civic medical officers say they handle complicated pregnancy cases if these are referred from PHC. So, we have to suffer because of the vacancies," said a doctor.

The undersecretary of the committee, Vijay Komatwar, said, "We are visiting different talukas to assess if the government funds for the welfare of women and children in Palghar district are properly executed or not. There are 10 MLAs and 5 MLCs who are fanned across the district to check all the departments including hospital, ashramshalas, anganwadi, police, etc. where the government has allocated funds for their welfare." The report will be submitted to the heads of the departments concerned. Palghar Collector Manikrao Gursal confirmed the visit.

‘Does any really care?'

"The state of health infrastructure is in a dilapidated condition because of the political will of the government. The state's budget for health is not adequate, and the allocated budget is not disbursed then how will its infrastructure improve? From 2009-10 to 2019-20, R6,763 crore [3 per cent of the budget] was spent on the public health department in 2015-16 and Rs 8,770 crore [3.06 per cent] in 2017-18. This is the highest amount ever," said Vivek Pandit, chairman of a government-appointed committee to look into the status of schemes for tribals in Maharashtra.

"I wonder how these visiting MLAs are going to create the political will to improve the health infrastructure of the state," said Pandit, adding the state's crumbling health infrastructure is not a secret. "Women and children are dying and people have become used to it by now. The committee members must be facing a similar crisis in their own constituencies," said Pandit, who fights for the rights of tribals. Calls and messages sent to Principal Secretary of Public Health Department Dr Pradeep Vyas went unanswered.

294
No. of child deaths in Palghar in 2021 due to various reasons