One health centre to save lives of hundreds of tribals
HYDERABAD: Five hours after being bitten by a venomous snake, a tribal man was brought to the Community Health Centre (CHC) at Eturnagaram in Mulugu district on August 5. The crucial ‘golden hour’ was already missed as he was first taken to a quack. By the time he reached CHC, the patient started developing complications. The doctors at the CHC administered anti-venom and referred him to the district hospital. However, he died on the way.
is fixed using a bandage
Amidst a severe shortage of doctors, referring cases to the district hospital is a daily practice for the 30-bed CHC situated in the remote tribal region, near the Eturnagaram Wildlife Sanctuary, which is close to the Telangana-Chhattisgarh border.
Even though the centre is being managed efficiently with the available infrastructure and manpower, it needs to be upgraded to an area hospital to be able to serve the large number of tribals who seek medical assistance. It is the only CHC in the area on which the tribals like Gond, Gutti Koya and Nayakpods are heavily dependent.
Even though the CHC is a referral point to nine PHCs in Telangana, tribals from some of the villages in Chhattisgarh also seek treatment there. After the construction of Mullakatta Godavari bridge, transport is now a little easier for the tribals. However, there are quite a few villages that do not have road connectivity.The Eturnagaram CHC receives about 250-300 outpatients daily, of which 150-200 are for antenatal check-up.
The Venkatapuram Primary Health Centre, located about 40 km from the CHC, has recently been upgraded to a CHC. However, it’s a small facility with limited infrastructure. In the absence of any other centre, patients have no other option but to travel 60 km to Mulugu in case of complications.
The CHC refers almost 60-70 patients monthly to the district hospital in Mulugu, most of whom die on their way. During the recent floods in the Godavari which flows close by, all the pregnant women in the nearby villages were admitted to the CHC. When all beds were occupied, the administration used empty ones in the ICU ward accommodate 25-30 women.
“A tribal woman, pregnant for the fifth time, with a history of two live births and two abortions, arrived in an emergency condition. We had actually referred the case to the Mulugu district hospital. However, as the roads were inundated, they could not go,” said G Swaroopa, a midwife working in the CHC.
After obtaining consent from the relatives, she did the delivery normally. Luckily, both the baby and mother survived. Anaemia is high among young girls in the region. A lot of pregnant women do not disclose that they are pregnant adhering to their customs and some superstitions.
Till the time the ASHA worker herself meets them, crucial 4-5 months would have been lost in which the women would have been better with the help of nutrition supplements.“There are instances of delivery happening in the jungle. They come to us with vaginal tears and heavy bleeding. Still, they don’t let us touch them,” said Jyotsna, another midwife working in CHC.
As the tribals, especially from Chhattisgarh, speak different languages, it becomes difficult for them to communicate with the CHC staff. They feel that they do not belong to civilisation, and due to fear of cities, tribals avoid going to the Mulugu DH even when referred.Pregnant women are also asked to go to the district headquarters hospital for a TIFFA scan which is done between 18 - 22 weeks to screen abnormalities in the baby.
It has been a year since Tribal Welfare minister Satyavati Rathod inaugurated the 50-bed Mother and Child Health (MCH) building constructed at a cost of Rs 7 crore. The building is yet to be put to use due to some infrastructural gaps.
Similarly, the construction of T - Diagnostic Hub which has 15 rooms has been completed with Rs 1.30 crore in April this year. The building is still awaiting arrival of equipment to be installed at a cost of Rs 3 crore.
Lack of doctors
“The centre is well-equipped for a CHC. We have an ICU facility, four ventilators, and even an arterial blood gas analysis (ABG) machine to measure the balance of oxygen. However, there is no staff to handle the equipment and serve patients,” said CHC superintendent Dr Suresh Kumar.
Although the government is implementing online medical services from Nizam’s Institute of Medical Science or a facility from Bengaluru, having on-site doctors remains crucial for many reasons. Currently, of the 13 specialist positions, only two are filled. In 2018, six members were assigned, of whom only four reported. Of these four, two eventually resigned and the other two include the superintendent himself.
Since it is located in a tribal area, there is no need for super specialty doctors like a cardiologist or neurosurgeon. However, paediatricians, gynaecologists, and general surgeons are needed. The CHC even lacks an orthopaedician to fix fractures which is common in the area.
“One of the challenges is that there are no suitable facilities for doctors to stay in the area. Additionally, the quality of education is not satisfactory, making it difficult to bring families here. Travelling up and down consumes a significant part of the salary and time,” Dr Kumar said. He opines that giving additional salaries to the doctors may attract them to work in such remote parts.
Need for Area Hospital
After Dr Kumar took charge, patchwork on the old building was done. Still, due to the weakened structure, the CHC building leaks during rains. “Now that a government college is being established at Mulugu, the facility at CHC becomes another important medical facility and hence needs to be upgraded to an Area hospital,” he added.
Dr Kumar believes that if the facility is upgraded to an area hospital, with a new building and improved infrastructure, and more doctors, it will definitely be able to serve more efficiently.