VISAKHAPATNAM: Amidst the hundreds of patients moving in and out of the casualty ward of KGH eagerly waiting for doctors to attend to them, is Lakshmi, a resident of Vizag. She keeps shuttling between departments to find out where she should take her sick father-in-law who was sitting under a tree outside on a wheelchair, on the verge of losing his consciousness.
Finally, a nurse tells Lakshmi she should consult a neurosurgeon and quickly adds that she should come the next day as the doctor is busy. “Despite his condition, the staff told me to visit tomorrow. He is in a really bad state and I have been pushing him around in the wheelchair from department to department myself as there are not enough ward boys. I had to leave him under a tree for half an hour and repeatedly ask the nurse for directions,” she said.
Even as Lakshmi laments her predicament, the sole doctor in the casualty department tends to 40 patients, two-three of whom have been accommodated on each of the poorly furnished ward’s beds. The ward with just five staffers tends to 200 outpatients everyday and admits 120. Even as Lakshmi wheels her father-in-law in, a nurse looks up from her register and shouts at a ward boy to make them wait until some space could be arranged.
With 15 beds in non-MLC (medico legal case) and 6 beds in MLC, patients are adjusted to giving space to new patients. Meanwhile, the ward boy disappears. Someone explains to the nurse that he has gone to help a patient who needs an X-ray taken. Unable to find the patient a bed, a doctor tends to him on his wheelchair. “At least 15 major cases are reported everyday. At times, we take our patients to the trauma unit as well because it has only three nurses.”
“We are not able to handle patients peacefully. There are six doctors in shifts taking care of 40 at a time. They cannot take up other patients before their check up is done, unless the case is an emergency. In such a situation, family members of patients keep on asking us,” said a nurse at the casualty ward.
On an average, KGH, which has 3,448 outpatients and 1,391 in patients, has 7-10 non-MLC category and at least one MLC death per day. There are, on an average, 430 deaths per month, with approximately 14 deaths in a day. According to officials, a majority of the non-MLC deaths happen either due to old age or chronic diseases in advanced stages after being treated at private hospitals.
Patients, however, feel that they are being neglected. A question then arises: How can 222 permanent and 40 head nurses take care of thousands of patients? Despite 160 nurses being employed on a contract basis, a very few were on duty as they are not paid on time.
As per Indian Nursing Council (INC) norms, hospitals should have a 1:3 nurse to patient ratio in the general ward and a nurse for each patient in ICUs, but with more than 50 per cent shortage of nurses, the ratio is a startling 1:5. Of the total of 1,037 government allotted beds, there are 1,650 beds with the same nurse ratio maintained with no recruitments taking place since the year 2000.
“Compared to 2016, there is at least 50% decrease in the number of deaths per day, thanks to improved infrastructure, equipment and division of department. As the division is based on the type of the disease, we are able to manage things without any worry,” claims B Bhagya Lakshmi, AP Government Nurse Association president.
A nurse admits that they are unable to give proper care to patients because KGH is skeletal-staffed. Patients allege that the situation is so bad that patients can even lose their lives as it takes too long to reach them. The neonatal care department is one of the few units in the hospital that seems to be doing good. The number of infant deaths has reduced significantly. It is, however, short-staffed too. Seven staff attend to 60 infants and there are four ventilators. At night just three staff will be on duty.
“We are happy that there is a very good decrease in the number of infant deaths compared to last year. Adding to it, there are only two working ACs. In general, there should be a 2:1 staff to patient ratio for infants, but due to lack of staff, we allow mother to stay with their babies which is usually not allowed in the case of infants weighing between 1 and 2 kg as they get infected easily,” said a nurse at the neonatal intensive care unit.
Out of the total 3,385 infants patients at the hospital in 2016, there were 718 deaths, while in 2017, 417 of the 2,047 infants admitted between January and August, 2017 died. “A majority of the deaths occur due to infants being born with low weight. The major cause of the conditions is that the mothers are malnutritioned and often anaemic.
This affects the baby,” said a doctor. When contacted, RMO K S L G Sastry said the maternal and infant mortality rates had dropped. “At some wards, the nurse to patient ratio is just 1:60,” he revealed.