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On the trail of state’s missing rural doctors

ROPAR/CHANDIGARH:“Dr Dhira” opens the Primary Health Centre at Surtapur Farm (50 km from state capital Chandigarh) every day, but nobody turns up for treatment.

On the trail of state’s missing rural doctors

Patients queue up for getting medicines at the Community Health Centre in Chamkaur Sahib. Tribune photo



Vishav Bharti 

 Tribune News Service

ropar/chandigarh, may 2

“Dr Dhira” opens the Primary Health Centre at Surtapur Farm (50 km from state capital Chandigarh) every day, but nobody turns up for treatment. That does seem odd because this is the only government health facility catering to 30,000 people in 10 villages and claims to provide curative OPD services and pregnancy checkups and deliveries. 

Villagers, however, say they don’t have much trust in “Dr Dhira” and have a valid reason: Dhira may be referred to as a “doctor”, but he is a peon as per government records. He, on his part, doesn’t make any attempt to hide the fact. Insiders say that is how most of Punjab’s Primary Health Centres are run.

Dhira, whose real name is Randhir Singh, claims the pharmacist is on leave, though villagers say they have never seen one here. 

He can “do dressing” and knows what “medicines are to be given for common ailments”, but hastens to add that people are wise enough these days and take patients to Ropar for “serious problems”. But why does Dhira have to be the incharge in the first place?

The answer comes from Dhira himself. The “real” doctor — an MBBS medical officer — hardly gets time to visit the dispensary as he has to do at least seven (24-hour) night duties a month at the nearby Chamkaur Sahib Community Health Centre, which is a rural referral centre with specialist doctors catering to one lakh population.

Seven night duties means the doctor is occupied for 21 days a month, besides four weekly offs and government holidays.

Nidhan Singh, who runs a flour mill near the dispensary, says he has not visited the PHC in years. “They don’t have medicines and we find only the peon on duty there,” he says. So he prefers going to the district hospital at Ropar, which is 5 km away.

Take the example of the two other Primary Health Centres in Chamkaur Sahib area. Besides Surtapur Farm, Amrali and Boormajra PHCs fall under the Chamkaur Sahib Community Health Centre. All three are running without a medical doctor.

Doctors of two PHCs, Amrali and Surtapur Farm, have been posted at Chamkaur Sahib for night duties, so they hardly get time to go to the villages they are posted at. Unable to cope with multitasking, the doctor posted at Boormajra PHC — who was paid Rs 60,000 — left the job some time back. The centre is now being run by an ayurveda practitioner. As a result, one lakh people in 50 villages don’t have a government doctor.

Rural healthcare missing

“We don’t have any other option,” says Senior Medical Officer Dr Inderjit Singh Bhatia, in charge of the three Primary Health Centres.

The latest government data shows how people have lost faith in rural primary and secondary health services in the state. As per the  National Sample Survey Organisation data, which got completed in 2015, in Punjab only 29.3 per cent rural population gets itself admitted in public hospitals; 70 per cent go to private hospitals.

Even when it comes to OPD at the PHC or CHC level, the number of patients is very low as compared to private practitioners.

On the human resource in the health institutions in rural areas, according to the National Health Profile 2015, Punjab has 441 doctors posted at the Primary Health Centres. But most work on deputation at CHCs or at times even at district hospitals. There is a shortage of other staff too.

Way overworked

We trail the “real” doctor posted at Surtapur Farm and reach the Community Health Centre at Chamkaur Sahib. As per the Indian Public Health Standards, CHCs as the secondary level of healthcare were designed to provide 24-hour referral as well as specialist healthcare to one lakh rural population. Punjab has 150 of them.

It is around 9 am and the patients have started registering themselves for OPD. After 18 hours of Emergency duty, it is time for Dr Banmeet Singh to move to the OPD. He’s hardly examined three to four patients when there is a call from the Emergency. When he returns after 25 minutes, the number of patients has swollen.

He examines six to seven patients before he has to rush to the Emergency again. All day, he moves to and fro the OPD and Emergency. He also takes a round of the ward. One doctor is omnipresent in the only rural referral centre for 175 villages.

Dr Inderjit Singh Bhatia, in charge of the CHC and three Primary Health Centres, is candid: “We are managing with just two doctors against the requirement of seven. The centre offers deliveries 24X7 but doesn’t have a gynaecologist. And it is considered the best rural health facility in rural Punjab.”

He tells that every night their ambulance moves four to five times to and fro Chandigarh. “What else can we do since we don’t have any system to deal with an emergency, we don’t have any anesthetist,” he says.

According to Indian Public Health Standards, it is essential for a CHC to have a staff of 46, including seven doctors. However, at CHC, Chamkaur Sahib, there are only three doctors, including a Senior Medical Officer, who is a child specialist and remains busy with administrative work most of the time. Apart from him are posted a general surgeon, and an MBBS doctor.

The situation is no better when it comes to rural referral services in the state. 

According to the National Health Profile 2015, there are 202 specialist doctors posted at 150 CHCs. Most of the CHCs in rural areas are working with two-three doctors.

Who cares

It would be unfair to conclude that there is a lack of dedication on the part of Punjab’s medical staff as a whole. There is, however, a woeful lack of dedicated staff at the rural health centres. So much so that it makes one wonder: Is healthcare in villages really a priority with the government at all?

Urban areas the priority?

Three years back, the Punjab government had taken a decision to focus only on 100 hospitals and moved doctors out of rural areas and the Chamkaur Sahib Community Health Centre was on top. 

“The government has decided that it only wants to serve the urban people. They have completely betrayed the rural people. The number of beds as well as hospitals has consistently declined in the rural areas. People don’t have the same health services in rural areas which they enjoyed in 1980s and 1990s,” says Dr Pyara Lal Garg, a public health activist and former registrar of Baba Farid University of Health Sciences, Faridkot.

“The state has failed to increase the infrastructure in proportion to population growth. The institutional framework in rural areas has been stagnant for 30 years. Now, it meets only  50 per cent needs of the rural population,” adds Dr Garg.

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