A Saga of Neglect: Bihar’s Premier Hospital DMCH Turns Into a Virtual Death Trap

Darbhanga: In the middle of a havoc wrought in the country by the COVID-19 pandemic, government-run hospitals in Bihar continue to be on ventilator. When a mysterious fever claimed around 128 young lives in June 2019 in Muzaffarpur and adjoining districts, the state government and its healthcare infrastructure had come under the radar. But nothing substantial has changed so far.

A mere look at the Darbhanga Medical College and Hospital (DMCH) is a picture of the pathetic condition of the second best hospital in the state, which was established in 1925 as a ‘temple of medical learning’. It was upgraded to DMCH in 1946 and handed over to the government for proper administration. 

After entering the waterlogged campus, one immediately experiences a foul smell emanating from the garbage dumped in the hospital premises, which also attracts animals and other insects. The hospital administration has failed in maintaining even the minimum standards of cleanliness as biological, surgical and daily waste covers most of the empty areas and corners of the hospital campus.

Lack of even basic facilities and equipment suggest how neglected healthcare is in the state. The emergency ward is only a three-bedded facility, which does not have an emergency kit, emergency tray or even an oxygen kit. Because of the coronavirus infection threat, the operation theatre is closed these days, with all planned surgeries postponed. Only Casualty Operation Theatre (COT) is functioning with the limited resources it has.

Digital X-Ray machines have not been functional in the hospital for the past five years, allege insiders.  Installed years ago, when late Mahaveer Prasad, who was the minister for health in the erstwhile Lalu-Rabri government in the state, the hospital administration reportedly could not continue operating the CT scan machine in the hospital. It was restarted only after private player Medanta took it over and set up its radiology centre at DMCH under the public-private partnership model.

The most important facility of IVP (Intravenous Pyelogram), an X-ray examination that evaluates kidneys, ureters and bladder to help diagnose blood in the urine or pain in side or lower back, is also not available here. The 500-bed hospital did not have ventilators till the novel coronavirus infection spread in the state. Ten ventilators have been installed recently and that too in the makeshift corona-designated ward of the hospital.

With the total caseload of COVID-19 crossing over 1.22 lakh, death toll rising up to over 600, the DMCH has turned its newly constructed nursing hostel into a ‘corona ward’. It has 200 beds for isolation (quarantine), 100 beds in the COVID ward where moderate and serious patients undergo treatment and seven beds in the ICU, which houses patients who need oxygen and ventilator support.  

“Whenever any critical patient comes, who needs the ICU (intensive care unit) or ventilator support, we refer him to the PMCH (Patna Medical College and Hospital),” a senior doctor told NewsClick on condition of anonymity.

“I am a medical professional. I know how to treat patients and give the medical care he or she needs. But what do I do when I don’t even have basic resources to attend to a patient? The maximum I can do in this situation is to give proper suggestions. This is what happens here,” he added.

When asked if they had been provided with the PPE (Personal Protective Equipment), the doctor said: “The hospital administration has so far been unable to provide N-95 masks adequately; expecting PPE in non-COVID departments is a distant dream. We have been left to the mercy of God.” 

A senior resident doctor said the hospital procured ventilators only recently when it began admitting serious COVID-19 patients. “We are residents; we have no other option but to serve patients even in the absence of safety equipment. Our repeated requisitions land on deaf ears. The senior doctors, who are assistants or associate professors, are busy in their private practices. They either come here on call or whenever an inspection takes place,” he claimed.

In the Outdoor Patients Department (OPD), the medical staff complained that they did not even have hand gloves, forget about the PPE. “If we send a requisition of 1,000 gloves, we get 100. If it is 100, we get 10. This is the state of affairs. We often run short of basic medicines required for minor nursing,” said a nursing staff.

Neither doctors, nor the nursing staff in the OPD was seen donning PPE. There was no thermal screening facility at the entrance of any department in the entire hospital to detect suspected coronavirus patients. 

The OPD does not have toilets for patients and doctors. 

Also read: Jammu: Amid COVID, Water-Logged Bunkers Add to Risk for Dwellers in Border Areas

DILAPIDATED BUILDINGS

Declared unsafe for any activity way back in 2015 by the National Disaster Response Force (NDRF), the surgical department’s building at DMCH is still functioning.  A team of experts from Patna had reviewed the building and found G+3 defect, which means it is unfit for any operation. 

With concrete falling, the iron rods used in the roof, pillars and beams of the building are exposed to air and water and, as a result, are eroded. The beams have developed cracks. The walls are damp and in bad shape.

“Forget about the building, we are not even provided hand gloves in sufficient numbers. The operation theatres don’t have ACs functioning properly. We have a big operation theatre with two-three operation tables. And it has only one AC, which sometimes works and sometimes doesn’t. Because of heat, it becomes extremely difficult for us to wear a gown—which is necessary while performing surgeries. The trauma of working in such an abysmal condition affects our work. The lack of facilities and unpleasant working conditions sometimes result in negligence,” a doctor in the surgery department told Newsclick.

The drains in the hospital are open and overflowing, causing logging of stinking water in the premise of the building. The septic tank has leakage just beside the ward of patients.

Notably, the building, which is in shambles, has 70 beds for post-surgery care and 10 operation theatres.

The burn ward, which lies on the ground floor of this building, has been shut for a decade. Those who come here with burn injuries, according to a hospital staff in the surgery department, are treated with first aid only. “Those with less than 40% injuries are given first aid and referred to the PMCH. Serious patients with over 40% burn are not given even the first aid and directly referred as neither the hospital is equipped to handle them, nor it has specialist doctors to handle such patients,” he alleged.

The 12-bed burn ward was commissioned in the hospital in 1982.

INTENSIVE CARE, BUT WITHOUT ANY EQUIPMENT

The condition of the medicine ward is no different from other departments, except the fact the building, though also over 100-year-old, is in better condition. But its 10-bed ICU itself needs intensive care.

Overcrowded with patients and their attendants, the ICU does not have a single multi parameter monitor and pulse oximeter. The split AC is not working and a window AC is unable to keep the room cold. A few fans are in working condition, while others just hang still. The facility, where critical patients are given treatment, lacks proper hygiene.

“We always bring the pathetic condition to the notice of the in-charge, but they are least bothered. Since the hospital does not provide any facility, we cannot restrict the attendants from entering the ICU to take care of their patients. Though this facility is called ICU, it is like any other ward of the hospital,” said a nursing staff on duty when NewsClick visited the hospital.

The ICU in-charge was not available for comment. It was around 2 p.m when this correspondent visited the ICU, but the chamber of Dr (Professor) BK Singh and Dr RK Das, associate professor, was locked. 

Detailing the sorry state of affairs, a doctor in the medicine department said: “Here, you will find a cancer patient, an HIV patient and a TB patient lying next to each other in one ward. All the patients here are vulnerable as they have strong possibilities of contracting infections from each other. This is not only dangerous, but criminal. You are playing with the lives of the poor who cannot afford private. There are doctors who had to be treated for tuberculosis because they were exposed to infections while attending TB patients in absence of safety gear.”

He also complained about weekly shifts of 36 hours, once common toilet for both patients and doctors, poor condition of resting rooms and absence of paid leaves. “In a nutshell, we are suffering from mental trauma, harassment and fear for life,” he concluded.

Asked about the availability of safety gear in the time of pandemic, he said: “Except masks, we have not been given anything by the hospital. We somehow manage hand gloves from other departments.”

When reached for comments, Dr (Professor) CM Jha, head of the Department of Medicine, declined to make any official statement, arguing that the Epidemic Act (Epidemic Diseases Act, 1897) is enforced across India and the district magistrate is seized with the power to talk to the media.

Another very senior doctor agreed to go on record but refused to be named. 

Also read: The Pathos of the Makers

“Yes, the ICU or the entire hospital’s infrastructure for that matter is in extremely poor condition. We have already sent a requisition to equip the Medicine Department’s ICU and hope things will improve in the days to come. Majority of the buildings are a century old and no new construction or upgradation of the existing infrastructure has taken place for years. Construction of a multi-specialty hospital in the campus is in progress. Once it starts functioning, many issues will be resolved,” he said.

Asked why they had waited for this long to send the requisition, he said: “The fund we get is insufficient to upgrade the department. I will not blame the government. What can it do when the health budget of both the Centre and the state is nominal in comparison to developed nations?”

Asked why the government should not be held accountable as it is the one which allocates the budget, he nodded his head in agreement and smiled, dodging the question.

CORONA WARD LACKS MEDICINES

Senior and junior doctors deputed in corona-designated ward alleged that the facility has dearth of crucial medicines, such as hydroxychloroquine. 

“We don’t have an adequate supply of very important medicines to treat covid patients who need medical intervention. The antibiotic medicine to check fever and cough supplied to the hospital is of inferior quality, which works only on administering heavy doses. We don’t have supply of hydroxychloroquine,” said a senior resident, while also complaining about overworking and absence of senior doctors.

Asked to rate the government’s preparedness to fight the pandemic, he said he won’t give more than five marks [out of 10]. “The situation will worsen if the hospital administration does not increase the number of beds in the corona ICU. The footfall of serious patients is increasing day by day. Given the consistent rise in positive cases, the future seems to be horrifying,” he added.

Asked about the strength of doctors and paramedics in the corona ward, he said, “Forget about the doctors and nurses, even beds are not available for pregnant women.”

DMCH Medical Superintendent Dr (Professor) RR Prasad was not available for comment as he is quarantined after having tested positive for COVID-19. 

Deputy Medical Superintendent Dr Baleshwar Sagar, who has taken charge as the superintendent, too, declined to comment.

But a senior doctor in the administrative block acknowledged most of the problems and poor infrastructure. 

“The hospital has an open campus, which has five approaching roads. Different departments are kilometres apart in the sprawling campus spread over 300 acres of land, which was given by Maharaja Rameshwar Singh Bahadur — ruler of the Raj Darbhanga (Khandwala Dynasty) in the heart of the twin city of Darbhanga-Laheriasarai along with Rs 6 lakh for setting up the medical college in Darbhanga. The hospital has now dearth of funds to improve the infrastructure. The government has turned a blind eye. The administrative block where you are sitting right now gets submerged when it rains. All the rooms in the building had 1.5-feet water a few days back when it was raining. What else you can expect in this situation,” he added.

“We have informed authorities and ministers about the condition in the hospital, but nothing has happened yet. The superintendent has also written to them many times. If something is not done immediately, parts of the building can collapse,” he said.

Asked about the positive cases and number of casualties, he said the corona ward has a total of 40 patients, with 10 of them are on oxygen support. The number of deaths of COVID-19 patients recorded was 28 till August 6.

Also read: Bihar: Doctors Apprehensive After 23 of Them Succumb to COVID-19