The Health Department is working towards providing health care “to the last household and to the last person of the state”, .i.e., the Govt. Of Bihar is totally committed to building healthy people by making available quality medicare facilities at the doorstep of every citizen in the remotest corner of the state.

These are the golden words one may come across through the every document of the Department of Health, government of Bihar. You may also find similar claims on the website, its official website.

The state government in Bihar praises itself as an icon of 'good governance' at every next occasion. But doing the same in almost every official document seems rather cheap. At one can get tired of the repetition of term 'susasan'.

Anyway, there is a mammoth budget allocation for the health service sector in Bihar. For the year 2013-14 the expenditure for health sector is estimated at Rs. 3356.84 crore excluding the 410 crore for center aided schemes, adding which touches to the tune of Rs. 3766.83 crore.

The epitome of health services in Bihar is undoubtedly none other than the Patna Medical College Hospital or PMCH. Despite this fact, the situation here is horrific. Like other government hospitals, there is a great shortage of beds and other basic facilities. Even toilets, drinking water, bed and bed-sheets are not available. Medicines are either not available despite the fact there is a pre-printed list of generic medicines to be prescribed by the doctors. These medicines are supposed to be in stock anytime. But the reverse is the case. The hospital mafia works here in connivance with medical representatives of various companies and hence patients get discouraged after hours of queuing-up to their turn.

pmch1Lack of Instruments

It is difficult to believe that in this largest hospital of Bihar, even the BP (Blood Pressure) monitoring instruments are not available in required numbers. Doctors have to wait for their turn to get them. Doctors in surgery are helpless to use corroded instruments which were bought in 1980’s. As per hospital sources (doctors), surgical scissors, trocars, dressing forceps, suture prob, bone chisel, retractor, lancet etc., all are in bad shape as they are decades old. Several requests in this regard were sent many times to the concerning authorities but all in vain.

The doctors also lament that even after so many years; an MRI machine has not been installed in the biggest hospital in the state. This issue lingers for years and the Patna high court repeatedly gives directives from 2008 onwards. There are two things to understand. First, is it the task of the Judiciary to run a hospital? Second, if the government fails to run a hospital how it can claim of ‘good governance’?

The Public Private Partnership

It would be not a surprise if this 1675-bed Patna Medical College Hospital (PMCH) will soon be handed over to private parties under the masque of PPP (Public Private Partnership) mode. The failure of governance is obvious as most of the services have handed over to run under PPP mode. But neither the opposition nor the media objected to this.

PPP – The Doyen

Probably, PMCH is the only government hospital in the country which houses a private diagnostic facility to take samples and mint money from poor patients. The installation of private diagnostic facility, DOYEN, in the hospital premises under the aegis of ‘sushasan’ is extorting money. It charges almost 70 percent and in some case beat the market rate despite the fact that half of the expense is borne by the state. To cross verify the tall claims of ‘sushasan’ that through Doyen it is providing services at half of the market price I visited various diagnostic centers.

Thyrocare, the world class Lab for diagnostic service charges Rs. 270 for the combined T3, T4 and TSH test. The same test by DOYEN under PPP mode charges Rs. 275 for the same. As per norms DOYEN gets Rs. 270 more from the government as well. It means Doyen is making Rs. 540 for the same test which is being provided by the world class laboratory like Thyrocare at just Rs. 275. There is nothing but the smell of a rat.

pmch2PPP - Ambulance Service (108)

Similar is the case with the Ambulance-108 facility. Under the Patna municipal corporation area it charges a minimum of Rs. 300 from the patient. As per rule it gets Rs. 300 from the state as well, i.e., a total of Rs. 600 just to roam within city limits. And in most cases, it has to run just 2-3 kms. One shocking truth the 108 ambulance call center receptionist reveals on condition of anonymity is that they (staff) are ordered to avoid providing services to distant area as it makes them burn more fuel at the same charges (it has to cover the entire PMC area under the same charges).

PPP- The CT Scan

Despite several directives of the Patna high court during the last 15 years, even the basic facility of CT scan could not be made available in the PMCH by the government though crores of rupees have been spent from the state coffer on two occasions in the past. Ultimately, it was handed over to the PPP mode and 800 rupees were charged from the patients for the service and it is running well now. But what about those who could not afford either the private diagnostic centre or this PPP mode of care? In fact everyone but the government realizes that the PPP mode is a great scam here.

Several directives of the Patna high court on the ill-equipped condition of PMCH fails to bring any changes. Earlier too the court had to intervene even for the procurement of life saving drugs in the PMCH.

pmch3Uniform and Bed-sheets

To protect indoor patients from infections there is a provision to provide uniform to indoor patients. The health department launched this scheme with much fanfare and about one crore rupees was spent to buy patients’ uniforms in 2012. But patients are completely unaware about such facilities. Asking to a woman attendant of a patient in the Rajendra Surgical block, whether her patient got the uniform or not, she angrily replied "we are purchasing the medicines from private shops, we had to buy a blanket that is being used as bed-sheet this winter, and you are asking about the uniform"?

In fact, for more than a year, not a single indoor patient is being provided the uniform (Kurta-Payjama) due to malicious reasons. But it is not official. The dirty fact about this clean uniform project is that the washing charges for these uniforms are being billed and paid despite the fact that these uniforms are not in use. This raises a question mark on the wisdom behind spending such a huge amount of public money without any monitoring.

pmch4The ICU and the Emergency Unit

The intensive care unit (ICU) is one of the most important unit which helps in saving the lives of critically ill patients. But, unfortunately the surgical ICU of the PMCH, emergency unit is in great shortage of beds causes over 70 per cent of the patients brought to the hospital in critical condition die.

It is important to understand that most of the departments have their own ICU here. The importance of the ICU at the surgery department is most critical, keeping the high numbers of fatal road accidents and crime. Even the critical patients are left in general emergency due to lack of bed in ICU leading them for a sure death.

Any ICU requires at least one anesthetist on 24-hour duty, because it is under his supervision all the equipment, including the ventilator, function. Besides, at least two nurses per bed, along with several paramedical staff, are required round-the-clock. But the ICU here looks like a garbage dump.

The insufficient number of trolleys is another problem which makes the movement of the patients very troublesome. The condition is made worse as the paramedical staff uses these trolleys to transport medicines and bed sheets.

Last year the then Principal secretary of Health, Govt. of Bihar, Vyas Ji remarked that the government was committed to turn the all six government medical colleges of Bihar into centers of excellence. He also expressed his satisfaction over the condition of the toilets therein. Here is the copy of the official letter in this regard released and undersigned by him.

While the government seems busy in projecting new schemes with the mandatory Page-1 media coverage, the officers are reluctant to act even when such reports come into light. The response time is too long even for the set rules to implement.

It is natural to wonder why such reports are never published in the media. There are various reasons, from arm-twisting of media to obliging them under advertising greed. Furthermore, the hospital mafia attacked the media and cameramen in the past on many occasions while they dared to cover the menace.


amit sinhaAmit K. Sinha is a bilingual investigative journalist who works independently. For the last couple of years he is in Patna writing for many prints and portals.