Sahyadri Books Online Trivandrum.: 199 Introduction to: Are Our Women And Children Safe In Our Hospitals? P S Remesh Chandran

Monday, May 4, 2020

199 Introduction to: Are Our Women And Children Safe In Our Hospitals? P S Remesh Chandran

199

Introduction to: Are Our Women And Children Safe In Our Hospitals?

P. S. Remesh Chandran

Editor, Sahyadri Books & Bloom Books, Trivandrum

Image by ID 3151634, Pixabay. Graphics: Adobe SP.

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Deaths from adverse effects of medical treatment are increasing in the world, not decreasing. Now it is between 2,25,000 and 1,50,000 people dying every year this way. Three-fourths of these are from harmful drugs’ administration and one-eleventh of all from unnecessary surgeries conducted. Medication errors cause fewer deaths in hospitals compared to those from harmful drugs and unnecessary surgeries. An unbelievably great number among these dying are pregnant women and also unborn children who die with them.

When medical technology advanced, it was expected that the death of people from medical diagnosis and treatment errors will decrease. It did not. The twenty five years from 1990 to 2015 witnessed tremendous growth in medical advancement but during this period the number of deaths from medical diagnosis and treatment errors also increased by roughly forty five percent! Then what is medical advancement and where is it?

The hospital staff responsible for maternal deaths are primarily doctors and nurses, and secondarily paramedical staff like technicians, and lastly but over everyone else in responsibility the administrators of hospitals and other treatment facilities. Doctors are a good lot generally, interested only in saving lives. A few among them are but corrupt, greedy and incompetent for various reasons. The nurses are a totally devoted and caring lot except a few rotten apples among them, and such bad nurses are usually only a five among a hundred. The technicians are mostly learned and always overworked; only a very few among them are prone to making mistakes from ignorance, perhaps more from negligence. That is the picture at least in Kerala- the state with the highest literacy in India. Kerala’s doctors, nurses and medical technicians are sought after and much admired in many countries.

A word about them: The doctors, nurses and medical technicians of Kerala are the best in the world. The parts concerning them in this book are not intended to disparage them in anyway. This author himself has witnessed their selfless services and personal sacrifices on not a few occasions while working with them. Their love, kindness, caring and dedication have been acclaimed by people in all countries where they served and lived. Dispensers of virtues, they soothe, solace and heal people across the globe. Their virtues will be sung by the people there. Pardon me; but here it is the vices in the health sector of their native land that is sung here. Someday, you will understand why.

Along with treatment failures and errors and patient deaths, poverty caused by medical expenses often called as Iatrogenic Poverty is also increasing worldwide. It is roughly estimated that 1,00,000 families are reduced to poverty every year in the world due to heavy medical expenses. Debt, bankruptcy, attachment of incomes, confiscation of properties, eviction, impoverishment, and death- it is in that order that people perish of iatrogenic poverty. Health insurance coverage in developed countries is a joke. Health insurance in other countries is for namesake. The only desirable option is the Free Hospital System of India which even India is winding up under pressure from huge insurance corporations over the country’s top-most parliamentarians and politicians. In fact they own them or sit on their boards, like they do with petroleum corporations and keep oil prices soaring even when the world crude oil prices dropped below zero.

The introductory article in this book describes a few incidents of maternal deaths due to pure medical negligence which ended as homicides. It contains true stories from India, illustrating how unsafe the lives of our women and children are in our hospitals and how uncaring and incapable of taking any remedial or recriminatory actions at all are the submissive governments in crimes committed by the blue-collared and the gowned in India. The second part explores why and how women deaths happen too frequently and too widespread not only in Asian countries like India but in Europe, America and England as well to be ignored. The third part is an attempt to examine how India fares in this worldwide situation. The fourth part assays how these governmental crimes against women and born and unborn children could be prevented from happening.

The first part was ignited by several incidents the author witnessed or heard about while working as an employee in the government’s health department’s various offices and hospitals in Trivandrum district in Kerala, including the Directorate of Health Services, the State Health and Family Welfare Training Centre, a State Nodal Institution for Mental Health Care, a sub-district level Headquarters Hospitals and two Rural Hospitals in ministerial capacity for thirty two years. The other parts were written from memory on things learned during these incidents or after these incidents during service, or from general knowledge accumulated through years from reading, written actually after leaving service.

Hospitals are more virtuous places than being bad places. A few years back when this author was working in the office of a headquarters hospital, happened to note the virtues of a very good pediatrician who also was a Senior Civil Surgeon and the Medical Superintendent-in-Charge there. He was a very tall man with a very kindly face and gentle speech. Children were taken to his office room by mothers when he had completed his rounds in wards. He never insisted that they should be shown to him only during rounds or in the Out Patient Wing of the hospital. They could be shown to him practically anywhere. Wherever he was was his consulting room, including the roads and other buildings in the hospital’s compound. Most children were taken to him shrieking loudly without stop and gasping for breath. Don’t know what wonder it was but the babies stopped crying the moment they neared him or entered his room and looked at his face! Once, this author noted that he was prescribing strong medicines for little children.

Asked him why, knowing well that he must have some good reason. He told this author: “Remesh, they are brought to us in very painful conditions- conditions painful and unbearable to them. They are laboring very hard even to cry, even to breathe. Our first duty is to give them relief. With strong medicine, there will be immediate relief and then the body system and nature will take over. The body system and nature have everything to assist in treating and comforting a relieved child. We sure can give them light medicine in small dozes for several days but we will also be delaying relief also for days, and we will be keeping them in perpetual distress for many days which is not helpful. They have only a tiny body and cannot go on suffering through so many days. Moreover, as long as we give the child early relief, we will also be prompting the body system and nature to take over early.” This author was convinced. So, the immediate duty of a doctor is to give relief, not cure.

In that hospital, at one time there were quite a number of gynecologists. At one time, of the twenty two doctors posted there, seven were gynecologists. They themselves knew there were not that many pregnant women attending the hospital for them all but they arranged their transfers to this station through influence, looking just at the lucrative private gynecology practice the headquarters town would bring eventually. Whoever joined new was a gynecologist and there were not enough doctors in the other specialties. The other specialties became understaffed. It became a problem there because there was not that number of pregnant women coming to the hospital and there were also a great number of patients needing care in the other specialties. This benign Superintendent asked this author what could be done and was told he could sent a letter secretly to higher authorities describing the situation as ‘overcrowding of specialists in gynecology and dearth of doctors in other specialties’. A letter was handwritten for him so that even the typist would not know which he signed and sent by special messenger to the District Medical Officer of Health. All but two gynecologists were transferred out immediately and doctors in general medicine posted in their place. One of the transferred out later became the DMO and eventually the Director of Health Services and you can guess how eager she would have been to hunt the perpetrator of this letter. She never stopped. Incidentally she was also the character in the incident of patient homicide described in the first article. She excused the superintendent who signed and sent it but not the clerk who wrote it. As a doctor he had immunity from other doctors. They are a privileged lot who consider themselves above everyone else and beyond reproof- the god players!

Post Partum Surgery or PPS is a simple medical procedure for permanent birth control in a woman in which the surgeon seals or removes the fallopian tubules just after delivery to prevent pregnancy. As it is a simple procedure with minimal risk, the Government of India promoted it by offering remuneration to women who underwent this surgery. There were even PPS Festivals or Melas organized, with the inevitable uncleanliness and unhygienity accompanied and took away so many lives like those Government Eye Cataract Carnivals organized in open stadiums which left so many infected and blind. When this author was working as a clerk at the Taluk Headquarters Hospital, Nedumangadu, this amount of remuneration for women undergoing PPS was Rs. 145/- for the delivered woman and Rs. 155/- for the attending team to be divided among the surgeon, anesthetist, nurse, nursing assistant and hospital attendant. The surgeon was a very good one, his name actually a synonym of god but greedy. He even got an award for conducting the most number of PPS operations in the district, or was it in the state? As it was only a rural headquarters hospital there were not that number of delivered women for him to cut. It was believed that he cut a lot of women without informed consent from them or their relatives! On the second day of delivery any fool of a husband and the only accompanying male from the village will sign any paper waved before him by an authority.

Women came to office the day after delivery to accept this remuneration of a meager amount. As the office was a little distant from the maternity wards and the women had to walk a distance in the sun and stand a little time before signing the register, there were awkward moments. There were also a number of cases of bleeding. The author suggested why not the office go to the maternity ward and disburse the amounts. That job fell on him though he objected that since he was unmarried and single he couldn’t go. Anyway the job fell on him. Everywhere there were women in various stages of undress and awkwardness and after a week the sympathetic army-served medical officer-in-charge assigned the job to a female nursing assistant. It was a new world there in the maternity ward, where everywhere there were new comers to this planet. I was proud of these little citizens and those mothers and sisters who brought them to this world. And most of the women had undergone the PPS operation too to prevent still more little angels coming to this planet. But a few of these surgeries became botched up surgeries too women deaths, mostly double deaths, with the child also dying with them eventually. One such case from this hospital is included in the first article in this book along with other incidents from other states. (A more elaborate study on such cases which resulted in international agencies stopping the foreign funds of Kerala Health Services is included in this author’s book ‘WHO IMF IBRD and ADB Money to India Health Finances Human Rights Violations and Corruption’).

Once when this author was working at the office of the Mental Health Centre, Trivandrum which was also the nodal centre for the two other major mental health centres at Trichur and Calicut in the state, he was won’t to go to the outside and drink tea from a roadside plank tea shop. One very old woman was once standing there drinking tea and talking to the lady owner of the shop. From her language she evidently belonged to Trichur. The author asked her if she was getting good care at the hospital. She told she had accompanied her son to the hospital who was an inpatient under treatment there. Asked how good the hospital was and how she felt about it, she replied: ‘Son, this hospital is god; if it is not here where would I have taken my son to?’ So, a hospital is a god to these people. The author had heard doctors being described as gods but not a hospital. If a hospital is that good and a god to people, then it must be an abode of healing artists, not quarters of semi-qualified quacks.

This particular institution was started in the past as a treatment facility for communicable diseases and insanity by the Maharajah of Travancore, primarily to house and treat those in the royal household who had contracted these diseases, by housing them at a place not too far from the palace for these inmates to feel they were too far removed from their home. That is why it was situated very near to the palace, still is. Then it became a Government Mental Hospital after the amalgamation of the Travancore-Cochin States as the State of Kerala after the Indian independence. Then decades after, as mental treatment centres had become to have more mental health care than mental disease care to provide and also to avoid the term ‘mental’, it was renamed as Mental Health Centre. The arch of the board at the entrance records this institution as having started in 1870 A.D. in the English Era and 1046 M. E. in the Malayalam Era. These dates do not exactly correspond (as it shall not if it is a mental institution!). The corresponding Malayalam Era is 1045. Standing there, drinking tea with that poor mother on the roadside, the author looked at that ages-old name board and renamed the institution in his mind: His Holiness the Government Mental Heath Centre, Trivandrum, or even, to be exact, Her Holiness, the Government Mental Heath Centre, Trivandrum! Then isn’t it necessary to uproot and remove those few unholy presences from these sanctities? It is eventually to be noted that this institution completes 150 years of service in 2020.

This institution has its moments of glory and its lofty achievements. Of the Seven hundred plus inmates at a given time, more than half would be women. There will be a number of young girls among them. A dissatisfied and aggrieved young girl in North India or in a North Eastern Border State jumps into a train and arrives in Trivandrum Central or any other train stations in Kerala. She will wander through the roads for a few days or for even months without food and bath and a place to sleep. The wicked fellows would have abused her sexually. Without paternal and maternal care she would have been thinned and look a wretched human being. The caring people in that neighborhood would report to police. They will pick her, take her to a judicial magistrate and finally bring her to this institution by Police as a judicial admission. No name would be known or her origins. She will be washed, cleaned, combed, dressed in clean donation clothes, fed, examined, wounds attended to slept will with medication. Within months she will become a beauty and begin to speak about names, places, education. Language experts will come and begin interviewing. Her village, town, parents will be traced and informed through judicial authorities. Then accompanied by two or three women nursing staff she will be taken by train to her home, handed over to parents in police presence under judicial order. So the pet has gone home and the staff will weep for a few days at her remembrance. There will be newspaper reports, of course without revealing the real name. Scores of young girls were recovered and rehabilitated this way, all associated travel expenses being borne by the Hospital development Committee headed by the District Collector, not by the government.

Then government posted a new superintendent to this institution who not a psychiatrist but a non-practicing general medicine man. This petty little human being observed that the connected expenses of transportation and rehabilitation were ‘unproductive’ which could be ‘productively’ used for cultivating vegetables for patients’ diet ‘relieving’ government. So this accompanying and rehabilitating recovered girls to their states stopped and the vegetable cultivation lasted till the next drought. Now these recovered girls are known to be transported through police. No one knows what happen to them on the way or if they even reach their homes.

And this great institution has had it moments of disgrace and public shame too. The unnatural deaths of Sona and Geetha were two women death cases which have not still been explained logically. Geetha was a Trivandrum native and Sona was from outside the state. Another woman ‘mysteriously took her own life by hanging from her iron bed, sitting dead on the floor’. A Tamil Nadu woman- let us call her Tapasi- who was a bystander to a patient was allegedly raped by staff and the case ended in law court. Unable to handle the language of Kerala and persecuted and harassed by the whole trial system, and above everything else burdened with the heavy expenses of traveling to Kerala from Tamil Nadu for the trial this poor woman finally told the court she was not proceeding with the case. One morning dozens of women did not wake up in a female ward and the news spread and hordes of newspapermen and TV Cameramen flocked to the institution. Authorities arrived by express transport and a great enquiry was conducted by the vigilance wing of the health department. These female inmates were found to be ‘over-sedated from medicine’ which discovery and phrase pleased everyone- authorities and the press alike. One was nurse was removed. The fact was, these patients usually threw the medicines out through the windows into the nearby woods or just flushed them out after the ward nurse who distributed them had withdrawn. That particular day this particular nurse watched over and ensured that they all took their medicine which was diazepam mainly. Hence they were not waking up the next morning. It was not ‘over-medication’ as the authorities phrased it but it was the first time they were taking any kind of medication for a long time!

Today, in institutions such as these, patient suicides and murders continue- unquestioned, un-prevented, uninvestigated. Public works department officers, works contractors and top-level bureaucrats in government make millions out of these institutions by way of ballooned up work estimates, bogus bills and no-sooner-it’s-completed-than-it-leaks works. Today this particular institution is a tourist paradise- anyone can go in there with a camera or a mobile phone and shoot and photograph- a naked violation of international patient privacy rights. No administration, no monitoring, no control because psychiatrists are not the administrators there now, after the government introducing Specialty Cadre for doctors under which any pen-pusher who has not had any patient contact for years can opt Specialty Cadre and become Superintendents in any specialty hospital in Kerala even without the mandatory recertification every five years. The health minister of Kerala tells press that she is the world’s foremost health minister and her department is the world’s best. And the press which is vigilant everywhere in the world bites it hook, stinker and line. Who is mad- those inside or those outside? Those inside who are mentally ill cannot speak coherently anyway.

Even before joining the health services department of Kerala as an employee, this author had been a frequent visitor to a medical students’ lodge and hostel during college days. That was when he learned about the various methods of ragging going on in medical schools with the objective of subjugating younger students and how pseudo doctors could go to seashore villages and rural inland hamlets and set up practice. Some pass the five-year medical course taking twelve years. Some never pass but still run lucrative practices. The author’s service in hospitals also added many more stories, and overwhelmed, the author could not help finally writing them. They were written in Malayalam as poems and published as ‘The Hospital Window’ (Aaspathri Jaalakam in Malayalam) later.

The author has written three other books exploring the injustices done to poor people in hospitals, altogether five including this one. ‘Doctors Politicians Bureaucrats People And Private Practice’ explores how and why they in the rural villages and semi-towns were skillfully deprived of the services of good doctors. ‘E-Health Implications And Medical Data Theft’ examines how patients’ private medical data is stolen and sold even by governments. ‘Did A Data Mining Giant Take Over India?’ is a look into how large and wholesale the governmental medical data theft and sale in India is. Because they are already covered in these books, a few relevant topics which were otherwise appropriate for this book are excluded. My readers are requested to read those books also to get a comparatively better picture.

The dead and the suffering in the hospitals have to have their voice because the first can never speak again and the second fear to speak. This book is dedicated to those women, old people and little angels who come to hospitals with no money in their pockets, undergo every injustice, discrimination, shame and medical crime poverty can subjugate them to in hospitals, and silently weeping say farewell to mankind and the world to go to other kindlier worlds.

The readers may have dissenting opinions on the views expressed by the author in this book but it can’t be helped.

Written and first published on: 21 April 2020.

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FROM THE BOOK:

https://www.amazon.com/dp/B087D34RVM

About the Author P. S. Remesh Chandran:

00. Author Profile Of P S Remesh Chandran By Sahyadri Archives.

Editor of Sahyadri Books & Bloom Books, Trivandrum. Author of several books in English and in Malayalam. And also author of Swan: The Intelligent Picture Book. Born and brought up in the beautiful village of Nanniyode in the Sahya Mountain Valley in Trivandrum, in Kerala. Father British Council trained English teacher and Mother University educated. Matriculation with distinction and Pre Degree Studies in Science with National Merit Scholarship. Discontinued Diploma studies in Electronics and entered politics. Unmarried and single.