Three years ago, Kerala’s northernmost Kasaragod district turned into India’s pandemic capital with the largest number of Covid-19 cases reported.
Back then, Kerala’s Left Democratic Front (LDF) government approached corporate major Tata Group to set up a greenfield hospital in record time.
Known for its relatively poor healthcare facilities, Kasaragod always depended on neighbouring Mangaluru city in Karnataka for emergency treatments and complicated medical procedures.
When Karnataka closed its boundaries as Covid-19 case numbers rose in Kasaragod, the whole district plunged into a severe healthcare crisis.
Responding to the demand from the government, the Tata Group created India’s first exclusive Covid-19 treatment hospital using modular prefabricated units matching shipping containers with over 540 beds in just 124 days.
Compliant with government guidelines for Covid-19 patients, the facility was manufactured in different units across the country, transported to Kasaragod, and assembled at the site.
The group spent ₹60 crore from its corporate social responsibility (CSR) funds for the hospital.
It comprised 80 quarantine rooms with 400 beds, 24 isolation rooms with 96 beds, two observation rooms with 10 beds, and one resuscitation room with five beds.
The hospital also had 10 rooms for nurses and doctors to rest, a waiting room, a canteen, a pharmacy, and ECG, X-ray, and ultrasound rooms.
Fibre-reinforced polymer composite sandwich panels were used for the containers’ longevity. So far, the hospital has treated 4,987 Covid-19 patients.
What happened?
While inaugurating the hospital, Chief Minister Pinarayi Vijayan pointed to Kasaragod’s lack of tertiary healthcare facilities.
He said there would be efforts to convert it into a permanent speciality hospital after Covid-19 was in the rearview window.
Now, almost two years and four months since its inauguration, Vijayan’s government is preparing to dismantle the modular prefabricated units, which have started to degrade beyond the point of repair.
The government agrees that the Tata Group handed over units saying they could survive extreme weather conditions for at least 30 years, it is the lack of proper maintenance that has created the current situation where the conversion of the existing facilities into a speciality hospital is not possible.
A high-level meeting attended by Health Minister Veena George and five MLAs of the district came to the decision to move ahead with the dismantling process under an expert committee.
This is happening at a time when Kasaragod’s endosulfan victims are demanding an exclusive hospital for their frequent admissions for continued treatment.
Promises made, not kept
According to Veena George, the containers would not last long, and dismantling was the sole option.
She claimed that the construction of a permanent concrete structure to accommodate a specialist hospital would begin there soon.
The MLAs promised to contribute from their asset development funds if the government constructed a speciality hospital.
But the move to replace the available structure with a concrete building has sparked heated discussion across the state, especially because the Tata Group said the structure might have lasted at least 30 years if sufficient maintenance was provided.
Sources in the Health Department confirmed to South First that the structure had turned junk in hardly three years, and most roofs were leaking.
They also say the floor with plywood was a fire hazard. There was no basement for the containers that are spread over 1.84 acres or 80,000 sq ft on a five-acre plot provided by the government.
The state government also claimed that managing a vertical building was easier when compared with the numerous containers assembled on a big campus.
Such a facility needed more staff, said the department officials.
The state government spent ₹15 crore to construct an approach road to the hilltop hospital other than to ensure uninterrupted power supply and sewage management.
Kasaragod’s plight
Meanwhile, medical practitioners, health experts, and civil society organisations say the construction of a new structure needs more public money, and the need for Kasaragod is not new buildings but specialised doctors.
Health facilities, including the recently-started Kasaragod Medical College Hospital, are struggling because of the lack of an adequate number of doctors, they said.
According to public health activist N Subrahmanian, the medical college hospital needs additional funds to complete some of its essential blocks.
Work on the Medical College Hospital is incomplete because the government has not paid arrears to the extent of ₹8 crore to the contractor, he said. The contractor has approached the high court seeking its intervention to clear the bills.
In the case of the Kanhangad Women and Children’s Hospital in the district, which also started after the Covid-19 crisis, the staff shortage is severe.
“Why is the government hurrying to dismantle the Covid-19 hospital without probing options to maintain it by conducting essential repairs? Instead of dismantling it and building a new structure, the government must address the shortage of doctors and nurses across the northern district,” Kasaragod’s Lok Sabha member Rajmohan Unnithan told South First.
Not an isolated case
Unnithan also said the condition of five taluk hospitals in the district was also abysmal, with each of them suffering for want of enough specialist doctors.
As per the government’s staffing plan, a taluk hospital must have at least 128 employees, with 40 nurses and 23 specialist doctors.
The plan also says there must be at least four specialists in gynaecology and obstetrics, four paediatricians, two anaesthetists, three general-medicine specialists, two surgeons in the general category, two orthopaedic surgeons, and at least one specialist doctor each in ENT, pathology, dermatology, physical medicine, and rehabilitation, psychiatry, and one in dentistry.
None of the district’s taluk hospitals has anaesthetists, so they cannot take up childbirth cases or conduct surgeries.
In the case of the taluk hospital in Trikaripur, it has only one paediatrician and one gynaecologist for outpatient consultations.
The hospital lacks a casualty wing because all four posts of casualty medical officers are vacant.
In the case of taluk hospitals in Nileshwar and Poodamkallu, they are managed by a general medicine doctor and a paediatrician.
A lone general medicine doctor runs the taluk hospitals in Mangalpady near Bedadka.
More neglect
“The Kasaragod District Hospital is under huge stress because of the lack of facilities in the taluk hospitals and the lack of doctors and specialists. The government must strengthen the taluk hospitals and Primary Health Centres (PHCs) to ease the pressure on the district hospital. But the government’s focus is fully on civil construction activities,” said a senior health official in Kasaragod.
Across the district, no taluk hospital attends to childbirth cases, and they are referred to the district hospital. That hospital itself lacks a forensic surgeon.
The Kasaragod General Hospital has one such surgeon, who is expected to do post-mortems round the clock.
No doctor can make a radio diagnosis in the entire Kasaragod district.
The district hospital also lacks a urologist, medical oncologist, cardiothoracic surgeon, paediatrician, or gastroenterologist.
Despite creating 191 vacancies of doctors and nurses in the Covid-19 hospital, the government has already transferred all of the medical professionals employed there to other hospitals in the state.
Currently, a block of the hospital is being used as a rehabilitation and daycare facility as part of the district mental health programmes. As many as 28 patients are using it.
