What This Kolkata Hospital Reveals About Public Healthcare Facilities In West Bengal

The first person who greets a visitor, ailing or otherwise, to Seth Sukhlal Karnani Memorial (SSKM) Hospital, the first healthcare facility in the country which traces its origins to 1707, is a tout. A tout who offers to fast track an appointment with a doctor, arrange for a stretcher and then a bed and even get nurses and ward boys to attend properly to a patient. The tout is perhaps the most important cog in the wheel that keeps SSKM, which is Bengal’s premier government hospital and a post-graduate medical education and research hub as well, creaking every day.

The hospital gets an average of 1,200 patients a day from all over the state. It has just 1,900 beds and on an average, only about 100 odd beds are vacated everyday. That means, only 100-odd patients can be offered beds everyday. But since there is a huge rush of new patients, and most cannot be turned away since they are emergency cases requiring urgent critical care, most patients are admitted and accommodated on floors of wards, the hallways, corridors, landing of staircases and every inch of space that can be found. On any given day, SSKM Hospital has more than 3,000 indoor patients, 1,100 of them without beds!

An acute shortage of beds is just one of the many problems plaguing this, and all other government healthcare facilities, in Bengal. There is also an acute shortage of doctors and according to the findings of this study commissioned by the state government a few years ago, the index of doctors’ involvement (IDI) – the ratio of actual hours devoted by doctors to OPDs to the hours they ought to devote – is an abysmal 0.44 across all government hospitals in the state. Then there is the shortage of medicines, negligence by doctors and para-medical staff, non-functional equipment that force patients to undergo tests at expensive rates in private facilities, lack of hygiene and cleanliness and extortion by touts.  No wonder, then, that by the government’s own admission, 79 per cent of the people requiring medical attention in the state prefer to go to private healthcare facilities. The remaining 21 per cent are too poor to even think of going to private hospitals.

The huge rush of patients, say doctors at the SSKM, is one of the primary reasons for the hospital bursting at the seams. “This is a referral hospital and almost all patients who come here have been referred by government hospitals in the districts or even in Kolkata on the grounds that those hospitals did not have the means to treat them. But many who are referred to SSKM Hospital could easily have been treated at the hospitals which refer them to us. They just don’t want to take risks or simply don’t want to work,” said a senior general surgeon who did not want to be named since he is not authorised to speak to the media.

SSKM Hospital underwent a facelift a few years ago and while many facilities for patients and those who accompany them have vastly improved, the underlying rot remains. Beyond the bright lights, the new gates and clean waiting halls for relatives of patients, there are open garbage dumps with even toxic medical waste, sewers inhabited by rodents, dirty wards, rusty beds, non-functional equipment and an air of despondency and neglect that makes SSKM a very sad and dangerous place to be treated in. Doctors admit that unhygienic conditions – the cleaners and other staff are grossly negligent and enjoy immunity from disciplinary action since they are patronised by politicians – make chances of secondary infections very high.

On an average, diagnostic and other equipment necessary to carry out vital tests remain unoperational for 55 days a year at this hospital. This is because of sloppy maintenance by technicians. Some doctors at the hospital allege that technicians, in collusion with touts who have a huge say in the functioning of the hospital, deliberately sabotage the equipment or say they (the equipment) need repairs in order to divert patients to private facilities in exchange for handsome commissions. Since all the patients who flock to SSKM Hospital are desperately poor, they can ill afford such extra expenses. There have been many cases of patients being taken away without treatment from the SSKM Hospital by the relatives due to the high cost of diagnostic tests in the private facilities they are often forced to avail.

The only silver lining at the SSKM Hospital is the availability of free medicines and the fair price medicine shops that operate there. These initiatives were undertaken by the Mamata Banerjee government soon after it came to power in 2011 and patients have benefited immensely from it. However, the government has been unsuccessful in controlling and abolishing the touts who have maintained their stranglehold on the hospital. “The touts have very strong links with para-medical staff and other staff like ward boys, lift operators, cleaners, ayahs and technicians. It is a mutually beneficial relationship between all of them – the touts extort money for everything and the others get a cut of their earnings,” said a senior doctor attached to the hospital.

One of the recurring and common complaints from patients and their attendants is ill-treatment and negligence of para-medical and other staff. Nurses and ward boys at SSKM, like their counterparts in other government hospitals in the state, are rude and extortionist. “They demand money for everything and if anyone complains, the treatment gets worse. They are the ones who actually run the hospital,” said Shomen Pal, father of Debjyoti Pal, 20, who was admitted to SSKM’s orthopaedic ward after meeting with an accident in the second week of March. Shomen Pal, who cultivates a small plot of land in Bardhaman and earns an average of Rs 7,000 a month, had to pay nearly Rs 12,000 to touts in the three weeks since he took his son to SSKM and till Debjyoti was released a few days ago. “The touts even took money for allowing us to take home cooked food to my son,” he complained bitterly.

Felines have a free run of the wards and dogs, many of them visibly mangy, bare their fangs at patients and people accompanying them. Touts, paramedics and other staff behave no better. SSKM’s doctors, an already harassed and overburdened lot, try to do their best, but that clearly is not enough. There are not just enough doctors to attend to all patients properly, even though the medics put in more than 14 hours a day, and often more, to uphold their Hippocratic oath. And that is what often puts them in conflict, at times violent, with relatives and friends of patients. Medics at SSKM Hospital often find themselves at the receiving end of the ire of patients’ relatives who feel that the former are not doing enough; but it is not possible for the doctors to do enough. The severe shortage of doctors is not going to ease anytime soon

Thus, despite SSKM Hospital being the premiere government healthcare institution in Bengal, and despite it having the best of doctors, equipment and facilities and many super specialities, it falls short of the standards expected of it.