Doctor shortages, infra gaps, and policy challenges affect Telangana's rural healthcare system; both patients and doctors are affected.
What's troubling Telangana's rural healthcare system? We find out. (Sumit Jha/South First)
On a bright afternoon in Eturnagaram town, situated in Mulugu district in Telangana, Rajaiah, his wife, and two-year-old daughter find themselves on a bench at the local government’s Community Health Centre (CHC). Hailing from Veerappur village, which is about 15 km away, they’ve come seeking medical help.
“My little one is struggling with diarrhoea and the doctors at the Primary Health Centre (PHC) in Chalpaka village recommended coming here. So, here we are, hoping for the best. They treated her and suggested that if she doesn’t improve soon, we should head to Mulugu district hospital,” Rajaiah tells South First.
He goes on to mention that the Mulugu district hospital is a considerable distance away, approximately 70 km from their current location.
Within a 50 km radius of Eturnagaram town, this CHC is the most substantial government hospital. It has well-equipped facilities, boasting a newly-constructed building with 35 beds and a 50-bed mother and child hospital (MCH) adjacent to it.
The laboratory facilities and a new digital X-ray machine contribute to diagnostic capabilities.
Rajaiah with his family. (Sumit Jha/South First)
However, the reality behind the scenes is quite different. The superintendent of the CHC, Dr M Suresh Kumar, reveals a stark truth, “Out of the 13 sanctioned permanent posts, only one is filled — that’s me.”
He continues, “We had a permanent gynaecologist until last month, but she also left.”
“Currently, the hospital is operating with only one permanent doctor, along with five doctors on a contract basis, including a dentist. While all the contract doctors are MBBS certified, I am the only specialist in the hospital, serving people within a 50 km radius,” Dr Suresh Kumar tells South First.
What happens in the unfortunate event of a person experiencing a heart attack in Eturnagaram?
“The initial care can be provided here. However, if the patient requires surgery, they would need to be transferred to Mulugu District Hospital. For more specialised cases, especially those requiring super-specialty care, the patient would have to be sent to Warangal,” he says.
When South First visited a PHC in the area, there was an MBBS doctor who was hired on contract basis. “We have the paramedical staff, but we need more doctors, otherwise we can’t operate 24×7. I start by 9 am and stay till 6 pm and, after that, in this forest area, I travel 13 km to my accommodation,” says the doctor.
At the Government Area Hospital in Kothagudem, a dedicated resident doctor, dispatched from Hyderabad for rural service, performed surgery on a patient. Following the procedure, the patient was initially moved to the ICU and later transferred to the surgical ward. However, the following morning, during the doctor’s rounds, a distressing discovery was made.
“The bedsheet was soaked in red and the patient was clearly in pain. The stitches had given way,” laments the doctor to South First.
Expressing frustration, the doctor recalls, “I had to perform another surgery on the patient. It raises the question of why proper care was not provided. When the patient started bleeding, the attendant sought help from the nurse. The nurse arrived, applied another layer of cotton around the wounds, administered medicine, and reassured the attendant that the patient would be fine in a few hours. Unfortunately, the attendants, lacking extensive education, trusted the nurse’s judgement and left it at that.”
B Narayana sitting outside the ward. (Ajay Tomar/South First)
The doctor goes on to shed light on the challenges of rural healthcare, “The nurse may not be adequately trained to handle such cases and make decisions about calling in the doctors. Additionally, the nurses are burdened with the overwhelming inflow of patients in the wards, making it challenging for them to provide individualised care. It’s a complex interplay of factors in rural healthcare settings.”
In Andole, Sangareddy district, in the wards of the 100-bed government hospital, 60-year-old B Narayana sits on a bench outside. “The room is stinking and there are a lot of mosquitoes, that’s why I am sitting outside,” he tells South First.
He adds that an iron rod fell on his feet. Later, he came to the hospital. “There was no electricity so the hospital staff were not able to do the registration and gave me cotton to cover the wound. I cleaned the wounds myself and put the cotton over it,” says Narayana.
One of the hospital staff, speaking to South First, says there are around 5 to 6 doctors/general surgeons from 9 am to 2 pm. But after that, there is only one doctor to attend regular cases as well as serious emergencies till 9 am the next morning.
“The hospital doesn’t have supply of oxygen in the ICU ward. The superintendent leaves the hospital after 2 pm to run his own clinic. The trainee medical doctors from MNR Medical College mostly come here and practice, and we are dependent on them,” says a member of the hospital staff.
At the government general hospital in Nagarkurnool district there are several pregnant women near the Gynaecology Department, forming a long queue.
Ramulu, a patient resting on one of the benches, shares with South First, “The situation seems to be the same every time I visit the hospital. With only one major hospital in Nagarkurnool for the entire population, we patiently wait for our turn. Sometimes, in emergencies, they let us in but we were informed that doctors also engage in teaching, causing delays. I’m here to get a prescription for the fever I’ve been suffering from for three to four days.”
The hospital shows signs of wear, with cracks on the mirrors, non-functional departments, and areas blocked off.
Outside the Area Hospital in Achampet, inaugurated months before the elections, a group of women voice concerns about delays in getting timely scans.
Sathiamma, 60, tells South First, “A group of women have come together and an Asha worker leads us. Today, she advocates for our pregnant women as there is no duty doctor, and the nurse isn’t conducting scans.”
She explains that the scheduled visit was not today, but rural people can’t keep travelling to the town. The new hospital faces issues — big boards, yet nothing seems to be working.
In a district hospital in Hyderabad, a line of patients await their turn to consult with the doctor. One patient, suffering from high fever, arrived at the hospital beyond the registration hours.
“I’m a daily-wage laborer, working at a construction site in Kondapur. Losing today’s wage is not something I can afford, so I decided to work until the afternoon and then come to the hospital just to get a tablet,” explains Suraj, a 36-year-old labourer from Jharkhand.
Regrettably, by the time he reached the hospital, the registration had closed. Disappointed, he left the premises without realising that emergency services were available, providing an opportunity to consult with a doctor or receive necessary medication.
“I noticed a doctor’s clinic just outside the hospital. He’s a registered medical practitioner. He gave me an injection and I recovered within a few hours, allowing me to continue my daily work,” recalls Suraj.
For Suraj, the primary concern was getting back on his feet, unaware of the potential side effects of the high-dose antimicrobial injection administered to him.
In Eturnagaram, nestled in a tribal agency area with the nearest city at a distance of 100 km, doctors who choose to work there often find the experience less than rewarding.
Hospital in Andole. (Ajay Tomar/South First)
A government doctor in Mulugu laments to South First regarding the situation, “After 12-13 years of struggle, earning an MD or MS degree and achieving the title of a specialist, if you end up in a place with zero facilities and meagre incentives compared to your peers, it’s natural to board the next bus and leave. Those who stay in such areas are either crazy or have done some crime to stay away from the city.”
The superintendent of Eturnagaram CHC, Dr Suresh Kumar, too, emphasises the challenges doctors face in rural areas. “When doctors come, they want good services for their families too — a quality school for their kids and adequate health services for their parents. Unfortunately, in tribal areas, finding such amenities is a daunting task. There are no good schools for children and specialty hospitals for the elderly are nonexistent,” he explains.
In Kothagudem, a resident doctor shares her perspective on the mandatory rural service enforced by the National Medical Commission.
“I am willing to do the job but being a woman, my duty hours are late and I’m in a rural area. The government doesn’t provide accommodation or transport. I have to fend for myself, and there’s always the fear that something might happen to me if I go home late at night. Consequently, I sometimes choose to stay in the hospital overnight,” she tells South First, shedding light on the additional challenges faced by female doctors in rural areas.
The major issue, which has been observed in Telangana, is regarding fewer doctors and less trained paramedical staff. But what about the recruitment?
Well, the government boasts of starting 21 new medical colleges since the state’s formation in 2014.
So for the nine new medical colleges which came up this year, the government started new recruitment. Out of the 1,442 assistant professor positions sanctioned by the government, the final selection list released in May revealed that only 1,061 applicants were selected, leaving 381 posts unfilled.
The recruitment process, covering 34 departments under the Directorate of Medical Education, saw the Obstetrics and Gynaecology Department with the highest number of vacancies, with 116 selected out of 187 sanctioned posts, followed by Anaesthesia, General Surgery, and General Medicine departments.
Other departments with insufficient recruitment included Paediatrics, Orthopaedics, Radio Diagnosis, and Pathology.
The Forensic Medicine department had 18 vacancies, followed by Community Medicine, Hospital Administration, Cardiacthoracic Surgery, and Physiology. The remaining departments had vacancies in single digits.
“Because of the government policy,” answers Dr T Kiran Kumar of Healthcare Reforms Doctors’ Association.
“Doctors who choose to enter government service after dedicating 12-15 years to obtaining their degrees require incentives. Firstly, government policies do not provide them with a competitive salary. Additionally, the government has imposed restrictions on newly-joined doctors engaging in private practice and there is a lack of government support in securing financial assistance,” Dr Kiran Kumar tells South First.
He emphasises that this is why doctors opt to join private institutions and practice in cities.
“I am stationed in a rural area far from home, 100 km away from the city. Despite receiving a salary comparable to that of a government UDC employee, the incentives are lacking. Even a traffic cops receive more incentives than regular police personnel as they stand in pollution, rain, or any weather. However, as doctors making significant sacrifices, we don’t receive any incentives,” Dr Suresh Kumar explains.
The female resident doctor in Kothagudem criticises government policies, stating that they often overlook the human aspect. While acknowledging the importance of rural service, she expresses concerns about the lack of facilities for accommodation, food, or any other incentives.
Dr Kiran Kumar adds that the House Rent Allowance (HRA) for a government doctor in Hyderabad is higher than that for a rural government doctor. He further highlights the restriction on private practice as an additional challenge faced by doctors in rural areas.
Regarding the training of paramedical personnel, all the doctors unanimously stressed the need to attract more doctors with attractive incentives. They believe that well-compensated doctors would be more motivated to provide careful training to paramedical staff.
Doctors point out that the environment for practices in rural areas is not conducive, contributing to the flourishing of quackery. Dr Kiran Kumar suggests that providing loans to open clinics in rural areas could foster healthy competition, build trust in hospitals, and offer healthcare options for those unable to afford private clinics.
He also advocates for involving private practitioners in healthcare initiatives, proposing the distribution of regular vaccinations from PHCs to clinics and nursing homes.
Private practitioners could charge a consultancy fee while providing vaccines for free, extending a similar approach to government-provided kits, such as the KCR Kits and Nutrition Kits.
According to Dr Kiran Kumar, this collaborative effort would contribute to the overall improvement of healthcare services.
(With inputs from Ajay Tomar and Deepika Pasham)
May 14, 2024
May 14, 2024
May 14, 2024
May 14, 2024
May 14, 2024
May 14, 2024
