The Shankarrao Chavan Government Medical College in Maharashtra’s Nanded district has been in the eye of a storm since September 30 when 24 deaths were reported in a single day. A fact finding team organised by a collective of health rights groups and activists has come out with its report on the deaths.
The report mentions that the healthcare support at the hospital is understaffed and overburdened while the medical college is dealing with an influx of patients that is several times its capacity.
Between September 30 and October 1, a total of 24 deaths were recorded which included 11 deaths of infants. The fact finding team visited Nanded on October 6-October 7.
As per the report accessed by Gaon Connection, this specific occurrence appears to be the case of an already overstretched system being pushed beyond the brink.
“The recent excessive deaths appear to be only the tip of the iceberg, which reflects a much deeper multi-dimensional health system crisis, extending far beyond the Medical college hospital,” the report filed by the Maharashtra-based Jan Arogya Abhiyan mentioned.
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The group of health rights activists mentioned in the report that the excess deaths in Nanded are not an isolated phenomenon.
“…rather they are more visible and extreme manifestations of a deepening, state-wide public health system crisis, reflecting a heavily over-stretched and under-resourced system which is now moving close to breaking point,” it stated.
Elaborating about the neonatal deaths in the hospital, the fact finding team found that in the NICU [Neonatal Intensive Care Unit] of GMC [Government Medical College] Nanded, the sanctioned beds /cradles were reported to be five, while existing cradles were reported as 20.
“However we were informed that actual admissions in the NICU are often 60 to 70 neonates. We observed that two to three babies were being treated on the same cradle, this is reported to be a common situation,” it mentioned.
It also pointed out that there are currently only two-three nurses per shift in the NICU, while according to the norms the nurse-patient ratio in NICU should be 1:2 per shift.
“Hence for an NICU even with 20 beds at least 10 nurses would be required in each shift, meaning at least four to five times higher number of nurses are required in the NICU compared to the present number. If we factor in the much larger number of actual admissions in the NICU (often 60+) then an even larger number of nurses would be required. There is no doubt that the current nurses in the NICU are overburdened hence adequate, increased staffing is urgently required,” it stated.
The fact finding team reported that overall there are five junior residents currently working with the Pediatrics Department out of which one or two junior residents are posted in the NICU to cover all the shifts.
“These residents are effectively performing the role of medical officers, requiring them to often work almost 24×7 which is likely to affect both patient care, as well as their ability to undergo the required specialist training expected during their MD [doctor of medicine] Pediatrics course,” it added.
The report further explained that to understand the crisis-like situation reflected in increased deaths in GMC Nanded, one must understand the context of inadequate specialist healthcare services in the public system, within and around Nanded district.
“It appears that there is no other well equipped tertiary public healthcare facility in the radius of over 100 km around Nanded. As a consequence, patients from across Nanded district (population in 2011 was 33.6 lakhs, now higher) as well as neighbouring talukas often seek specialised care in GMC Nanded,” it noted.
“Being a higher level, specialised referral facility, ‘the buck stops at GMC’. This medical college hospital cannot deny admissions, and they end up accommodating all incoming patients despite overcrowding and overstretching of existing facilities,” the report underlined.
Patients are frequently referred to GMC from other levels of public health services – from Nanded city, from the rural areas in 16 talukas across Nanded district, and from neighbouring districts of Maharashtra.
“According to the sources in the hospital whom we talked with, especially in the last two months there have been significant shortages of essential medicines like higher antibiotics due to insufficient and erratic supply, while patient load has been high,” the fact finding team mentioned.
