Hyderabad's Osmania General Hospital's reputation is a study in absurd contrasts. The oldest hospital in the city is a dilapidated heritage structure which perhaps best depicts the fallacies of the government when it comes to state-run healthcare.
On October 25, a Postgraduate student in the Dermatology department suffered head injuries when a ceiling fan dropped on her in the outpatient area. The incident does not shock the citizens of Hyderabad anymore. Parts of ceilings collapsing, inundation during heavy rains, patients lying on the floor, and dogs roaming between beds unabated are all part of the picture that forms in the regular Hyderabadi's mind when one mentions OGH, courtesy of what has been in the news and on social media.
Dr B Nagendar, Superintendent of OGH, says that the ceiling fan was 50 years old, and it is for the respective department to consider why it wasn’t replaced. “It was a very rare incident. It wasn’t because of the old building. It's an old fan. We have changed every fan here,” he claims.
OGH is the premier state-run hospital in the city, and for PG students who are serving there, what should have been a matter of pride has turned into a recurring nightmare. "People say that we are toppers. We entered these colleges with top ranks. We are working three to four times more than we need to. There is a shortage of manpower at OGH, and most tertiary care centres in the state. Per day here, 10-15 PG and senior PG doctors handle about 1,000-1,500 patients. There is a shortage of helpers, patient caretakers, wardboys and sisters. We sometimes handle their responsibilities also. That's a lot of stress. And if things go wrong, it is not because of the negligence of the PG doctors. It is the fault of the government who didn't provide manpower," says a PG student at OGH and a member of the Junior Doctors Association, Telangana (JUDA).
Staffing blues
Dr Nagender brushes aside these statements and says that there are two doctors available for each patient at OGH. “In each unit, we have two assistants, one associate, one professor, 15 postgraduates and 10 house surgeons at any given time. Bed capacity per unit has decreased since we stopped using the Old Block. But we have one doctor per patient. Let the students who make these claims come out with statistics, and then we will answer,” asking students to be clear about the areas and departments with staff scarcity. “Morning and evening we have ten house surgeons each, we also have Senior Residents (SRs), and six Casualty Medical Officers (CMO). I don’t think there is a shortage. They can come and speak with me if they have any problems,” continued Dr Nagender about the alleged staff shortage in the casualty ward, adding that the hospital has about 115 to 120 ventilators overall.
In 2018, The Hindu had reported that the hospital was treating 1,400 patients daily, as opposed to its allotted bed strength of 1,168. Budget and facilities are allotted to the wards based on the beds sanctioned. The report also quoted doctors saying that the hospital hasn’t adjusted the nursing strength since the 1980s, and often makes do with temporary nurses.
“When the students tell me where the shortage is, I will give them statistics. The postgraduates are also in the workforce. They should also work. There are 120 students in general surgery across three batches, orthopaedics has around 30 PGs each in three batches, and about 54 in General Medicine’s three batches overall, and 10 Senior Residents,” says Nagender.
When heritage trumps safety
In 2015, the state government had proposed a plan to demolish the hospital's building, and construct a new one in its place. This plan irked historians and heritage activists, who took the state government to court over it. And as things stand, the Telangana High Court is still hearing the matter. A member of the JUDA had some strong words for these "activists" as well, "People shouldn't suffer because of their heritage. When there's no safety for workers, what is the point in taking pride in heritage? It is illogical to say that the same building should be used for the hospital, a building that is going to collapse," they add.
In March this year, when the state's budget was announced, healthcare was allotted a mere 2.72% share, amounting to Rs 6,295 crore. While it was up by Rs 109 crore from last year, it is to be remembered that this allocation came during the pandemic, at a time when the second wave was building up as a very real threat in the country.
Ever since the latest incident, the junior doctors at OGH have been tending to their duties in helmets — a form of silent protest against the administration's failure to take any measures to prevent these incidents. They have also renewed their demands for a new building for the hospital. Protests in 2018 finally brought the curtains on the ancient Old Block of the OGH, and wards were shifted to the Quli Qutub Shah building. Surgeries were moved to a Greater Hyderabad Municipal Corporation (GHMC) building close by.
A dangerous work environment
Even these interim measures lay bare the callousness of the authorities in their handling of the matter. A former postgraduate student at OGH says that this has led to departments being staggered all over the place, adding to the woes of the doctors and patients. He also tells Edexlive that the state of the casualty department, with its lack of oxygen beds, and ventilators, is a cause for concern. "Every day, doctors work under threat that some wall or ceiling may fall on them. We graduate at the top of our class and are eager to provide service to the poor. But we come to work in a dangerous, hostile environment. The infrastructure needs to match up to the efficiency of the doctors," says the 2018 alumna.
And the toll that it is taking is heavy. "To be frank it is extremely depressing," he adds, "Many PGs get these kinds of ideas, of leaving the stream, the hospital, leaving medicine itself. But we are committed to our profession. We came in with passion and love, and even though we get these thoughts, no one leaves."
The lack of cogent security is another concern. "There is no security staff to control patients. Forget COVID-protocol, they allow mobs into ICUs and general wards. Just last month there were three incidents of junior doctors being attacked by the attenders," says a PG at OGH, calling junior doctors "scapegoats" of the government's failures. The Superintendent says that any such incidents are “sporadic” and legal action is taken against the offenders.
He had also said the same thing when a patient died in August 2020 because doctors in the casualty department did not have the facilities to treat the fracture he had suffered, according to a report by the Indian Express. He told reporters this time that the issue of the new building is in court, and these infrastructural problems will be sorted once the new building comes up.
