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You are here: Home | Public health | Agenda | Access to healthcare | Healthcare denied: Voices of the people

Healthcare denied: Voices of the people

Children dying of snakebite for want of anti-venom vaccine at the public hospital; patients dying for want of a respirator; women in labour turned away from a community health centre; life-threatening illnesses misdiagnosed.... These horrifying case studies and experiences recorded at public hearings in different states in 2004 by the Jan Swasthya Abhiyan, and by InfoChange Agenda correspondents illustrate the extent to which citizens are denied the basic human right to timely and effective healthcare

UTTAR PRADESH

 Raj Kumari , resident of Rampur Dullah village, district Devria, Uttar Pradesh, had tuberculosis of the bone. She had a persistent complaint of vomiting and headache but could not get diagnosed or treated at the district hospital. She had to approach a private hospital in Gorakhpur , where she was diagnosed with TB. She incurred an expense of Rs 12,000 in the private sector.

Type of denial
No diagnostic and treatment facilities at the district hospital.

Consequence
Heavy financial loss and delay in diagnosis of the illness.

Nazir Khan of village Kamalpur, Datawali post, district Meerut , took his child to the district hospital for a leg injury. After some delay the doctor referred Khan to a private clinic for an X-ray of the leg. He spent Rs 60, and took the X-ray back to the doctor. He was sent away and asked to buy expensive medicines from the market. A few cheaper medicines were provided by the hospital. Since sepsis set in, Khan had to take his child to a private nursing home where he was told that the child was seriously ill. The child is still required to go to the private nursing home for treatment. Rs 25,000 has already been spent on this episode. Now Khan has no money left for treatment.

Type of denial
Absence of basic facilities (X-ray) and medicines to treat minor injuries at the district hospital.

Consequences
Worsening state of injury and high cost of treatment incurred in the private sector.

Prahlad Prasad of Kuiya Kanchanpur, district Maharajganj, was suffering from a chronic illness (probably TB). He first approached the PHC. With no signs of improvement in his condition he went to Gorakhpur where he was advised an X-ray. Here he was diagnosed with TB. Since he was not satisfied with the services at the district hospital, he went to West Champaran , Bihar . He has spent around Rs 16,000 and is heavily in debt. He had to sell his ox, mortgage his land, and take loans from relatives. There is only a 50% improvement in his condition and he has to continue medicines for one more year.

Type of denial
Absence of basic facilities and medicines at the PHC and district hospital. No early diagnosis of TB, resulting in delay in treatment.

Consequences
Deteriorating health condition and high cost of treatment incurred at private nursing homes, resulting in indebtedness.

Nankai went to the community health centre (CHC) in Mohanlalganj, Lucknow , for her first delivery. Her mother was asked for Rs 5,000. She arranged the money. After some hours they were asked for Rs 10,000 more. Her mother expressed her inability to pay. They were thrown out of the doctor's room. Nankai delivered a stillborn baby at the gates of the CHC. She had to be admitted to the Dufferin hospital and still has a two-and-a-half-inch tear.

Type of denial
Denial of service, extortion, humiliation.

Consequences
Stillbirth, infection, financial loss.

NEW DELHI

Mangal Singh and his wife Mohini Devi had been working in the stone crushing and quarrying mines of Lal Kuan for the past 20 years. Both of them are suffering from silicosis. They went to the Nehru Nagar Chest Hospital for a check-up where both were diagnosed as TB patients and prescribed medicines. Mohini Devi's condition was fast deteriorating. She was taken to Safdarjung Hospital where she was immediately admitted. But due to the delay in treatment, she died the following day. At present, Mangal Singh visits Lala Ram Swarup Chest Hospital for his routine check-ups.

Gulab Devi , another worker in the Lal Kuan mines, complained about a wrong diagnosis of TB at the Nehru Nagar Chest Hospital . The medicines for tuberculosis she has been taking for a long time have caused damage to her kidneys and liver.

Type of denial
No infrastructure and facilities for diagnosis and treatment of silicosis; no compensation to mine workers.

Consequences
Chronic and fatal disease, high costs.

MAHARASHTRA

At one of the Narmada Bachao Andolan's (NBA) Jeevan Shala schools in Nandurbar district, northern Maharashtra , a girl student was bitten by a snake. The resident teacher hurriedly took her to the rural hospital. The incidence of snakebite in this area is very high, especially in the monsoons. However, there was no snake anti-venom available at the hospital, and the girl died. Activists from the NBA tried to persuade the hospital authorities to make anti-venom available immediately so that similar cases would not recur. Unfortunately, the drug remained unavailable at the hospital for more than a fortnight. During this period, two more girls died of snakebite.

Type of denial
Non-availability of essential medicines at the rural hospital, although incidence of snakebite in this area is very high.

Consequences
Completely avoidable deaths of three girl students studying at Jeevan Shalas.

One-year-old Pinty Bhanwar was taken to Vashila PHC in Thane district of coastal Maharashtra with acute breathing problems and swelling around the eyes. Although she was taken to the PHC during working hours, the doctor on duty was not present. The compounder at the PHC gave her some local application for the eyes. Pinty's parents waited for the doctor to come for around four hours; finally they decided to shift her to the adjacent Nandgaon PHC. The doctor at this PHC gave her an injection and tablets, assured her parents that everything would be all right within a few hours, and left the place. In spite of repeated requests, nobody at the PHC bothered to tell them what was wrong with their daughter, nor was the child admitted in the PHC. The parents had to keep the patient at a nearby relative's house. The child died the same day.

Type of denial
No doctor was available at the first PHC; the patient was not admitted at the second PHC. The doctor left the PHC, abandoning the patient.

Consequences
Death of the child.

Uttara Rupchand Dakhane , 25, resident of Ghati, Kurkheda taluka, Gadchiroli district, registered herself at the Kurkheda PHC for ante-natal care in mid-2003. On August 5, 2003 , she developed labour pains and was taken to Rural Hospital , Kurkheda. Medical officers were present at the hospital. Rupchand Dakhane asked the nurse to admit the patient in labour. The nurse told him to first get the patient registered. Once the patient was in the labour room, the nurse came and put the patient in position for delivery and left the room. Dakhane asked to meet another medical officer. This MO had a look at the patient and warned her husband that since the mother was very weak, this could be a complicated delivery and dangerous to her life. Despite this, the MO did not visit the labour room again. Finally the delivery took place without medical assistance. When the patient's husband reported the delivery to the nurse, she came and cut the cord. She did not ensure that the baby cried. The baby cried only when the dai (local midwife) cleaned her, nearly half-an-hour after the birth. After four-five months, the parents realised there was a problem with the child and took her to a child specialist in Nagpur . He diagnosed mental retardation due to negligence at the time of birth.

Type of denial
Negligence on the part of doctors and nurse. Denial of essential care to the newborn.

Consequences
Lifelong mental retardation.

Kusum Mali was taken to the Osmanabad Civil Hospital in Marathwada, Maharashtra , with complaints of a high fever and numbness in the extremities. She was diagnosed with typhoid (without a laboratory test) and treatment was started. Since her condition deteriorated, she was taken to a private hospital where she was diagnosed with a much more serious illness, GB Syndrome. Since her family could not afford to treat her at the private hospital, she was again shifted to the Civil Hospital . Her condition deteriorated further and she had acute respiratory problems. She was in urgent need of a respirator, which was not available at Civil Hospital . It was not available even at the main hospital in neighbouring Solapur district. Her relatives had to rent a respirator from a private hospital at Rs 1,500 per day. Precious time was lost during this exercise. Relatives were also frequently asked to buy medicines from outside. This resulted in severe financial loss; relatives had to sell ornaments and borrow from the moneylender. But the delay in treatment irreversibly damaged the patient's health. She died.

Type of denial
Essential equipment (respirator) not available at the district (civil) hospital level. Failure to diagnose a life-threatening ailment.

Consequences
Death of patient. Catastrophic financial loss to the family.

The need for public healthcare in the urban jungle

Surely public healthcare would be more accessible in the commercial capital of the country? Not really. In 1996, Sonya Gill and others interviewed OPD users in Mumbai's KEM Hospital , a tertiary care centre in the middle of the city. They found that 54% came from the urban unorganised sector. Over two-thirds had earlier gone to a private doctor but shifted because the treatment didn't work, or it became too costly. Why don't they go to the urban health centre? Because there was just one municipal dispensary for a population of 50,000 -- compared to a private practitioner for less than 2,000 people in the ward where the hospital was located. The dispensary could hardly match the coverage of the private sector or consider itself the main provider of first-level care.

Dharavi is a large settlement in the centre of Mumbai. Renu Garg found that residents of Dharavi rarely used the urban health centre. They went to private doctors for minor problems or the public tertiary hospital for major illnesses. When researchers interviewed patients in that tertiary hospital they found:

  • 3.2% were not provided beds, 19.5% were not provided linen, and 16.3% were not given hospital clothing. 21.1% of linen and 27.6% of hospital clothes had never been changed.
  • 68.1% had to buy medicines from outside pharmacies. One out of three had to get tests done outside.
  • Still, overall patient satisfaction was high. Only the poor come to public hospitals, many of them after being exploited and neglected at private hospitals.

Researchers T R Dilip and Ravi Duggal surveyed inhabitants of a densely populated ward in Greater Mumbai with a predominantly lower middle class population. They found that financial reasons forced 30% of those surveyed to travel to another ward for public sector in-patient care. Fifteen per cent went outside for outpatient public care. Apparently for this group, the cost and inconvenience of travel was less than the cost of a private hospital. Though the majority of households used the private sector for outpatient care, and slightly fewer for in-patient care, a substantial percentage of households said they'd rather go to the public sector if it were available in the locality.

Sonya Gill, Lalith Dsouza, Anagha Pradhan and Dina Patel, Hospital based urban health care services, Foundation for Research in Community Health, Mumbai, 1996

Renu Garg, Improving the performance of reference health centre: a case study of urban health centre, Dharavi, Mumbai . TISS, 1995

Aditi Iyer, Amar Jesani and Santosh Karmarkar, Patient satisfaction in the context of socio-economic background and basic hospital facilities: A pilot study of indoor patients of the Lokmanya Tilak Municipal General Hospital , Mumbai. CEHAT, Mumbai, 1996

T R Dilip and Ravi Duggal, A Study on demand for a public hospital in K-East Ward, Greater Mumbai. CEHAT, Mumbai, 200

InfoChange News & Features, June 2005