Ailing healthcare services in Uttarakhand's hilly areas forces migration to urban centres; lack of doctors cripples hospitals

Editor's Note: The idea of a 'ghost village' is now a reality in Uttarakhand, where remote villages in the hills lack basic amenities like roadways, health centres and schools. This seven-part series will examine the root cause of this migration and the measures being taken to tackle the problem.

Read the series here.

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Dehradun: "Isn't it ironic that in a 'devibhoomi'  — as Uttarakhand is called — people's lives are in 'Ram bharose' (in god's hands)?" asked Indresh Maikhuri.

The 42-year-old social activist and political worker from Karnaprayag of Chamoli district is referring to the over 40 percent vacancies for doctors in the state, of which 80 percent of the openings are for super-specialists.

According to a report by the Rural Development and Migration Commission, 8 percent of residents have migrated out of Uttarakhand's hilly areas to urban locations due to lack of medical facilities. The fact that doctors born and brought up in the hills are not ready to serve in its remote areas has become a matter of grave concern.

"Our state turned 18 just a few months ago (in November), and yet, we do not have enough doctors at health centres here, especially in the remote hilly areas. Sure, government hospital buildings look swanky and modern, but what is the point of that if the number of people being treated and cured is abysmally low? That's why more and more families are migrating to urban areas," Maikhuri rued.

"This sorry situation extends to all government hospitals in the Garhwal division. Right from Rudraprayag to Srinagar, every hospital has been transformed into a mere referral centre instead of one that actually provides treatment. Even Srinagar's government medical college faces this problem due to insufficient specialists. In such a scenario, the poor are living in 'Ram bharose', while those who have money are shifting to Dehradun and other better-connected areas."

The activist added: "Just a few days ago, a woman in Karnaprayag died because she didn't receive the right treatment. And she wasn't the first either. There have been several cases of pregnant women delivering their babies on roads and in other unsterile conditions."

From Garhwal to Kumaon

While Maikhuri's revelations do paint a dark picture of what's happening in the hilly districts, government hospitals in the plains fare no better.

"The largest government hospital in the state is the Doon Medical College Hospital in Dehradun, where thousands of patients from the hills are sent for treatment. One would expect at least that facility to have its act together, but alas! The hospital has often courted controversy over lack of sufficient services. Just last year, it ran out of oxygen for the 18-odd patients who were affected by a chlorine gas leak and then sent them packing to a private hospital. This year, a woman's body was found in a toilet on the premises, while nine women had to deliver their babies in torchlight and candlelight because the power was out and the hospital didn't have a generator. I myself have seen a person carrying his dead family member on his shoulder after the hospital failed to provide him with a stretcher. If this is the situation in the capital, you can imagine how it must be in the remote areas," he explained.

Ailing healthcare services in Uttarakhands hilly areas forces migration to urban centres; lack of doctors cripples hospitals

A district hospital in Tehri that the government runs in a PPP mode. Image Courtesy: Rahul Singh Shekhawat

Although Maikhuri mainly highlighted the situation of health services in Garhwal, those in the Kumaon division aren't in a better state either. A combined health centre (CHC) in Gangolihat town, Pithoragarh district, is facing a shortage of not only doctors but also of paramedical staff, and while the Pithoragarh district hospital is the only one with an ICU, local residents say it's a showpiece and doesn't have sufficient staff.

Govind Singh Bisht, a 61-year-old native of Almora district's Patia village in Kumaon division, said, "My village is in the Takula development block. I don't see much difference in Uttarakhand from the time it was part of Uttar Pradesh. The whole point of a separate state was to give locals from the hills more facilities and a better life, but not much has changed. Our district headquarters is 15 to 20 kilometres away from the village. We had to go all the way there for treatment during my childhood and even now. The only difference is that earlier, we went in palanquins and now, there is a road. Small mercies!

"I don't know on what basis the chief minister is making claims of having made enough doctors available. Not just government hospitals, even primary health centres, CHCs and district hospitals are being operated on a public-private partnership (PPP) mode."

Bisht added, "I used to work in a bank. I am retired now and have shifted to Almora. I ache for my native place. I wanted to spend my retirement there in peace. But with it lacking basic amenities, I can't go back."

A crippling crunch

Navin Karki, acting chief medical superintendent of the Gangolihat CHC, said only four of the nine sanctioned openings for doctors and one of the eight vacancies for paramedical staff have been filled.

"Not just that, a doctor was selected and appointed under the State Public Service Commission, but the medico still hasn't reported to work. We finally had to alert our seniors about it," Karki added.

A district hospital in Bageshwar, Uttarakhand. Image Courtesy: Rahul Singh Shekhawat

A district hospital in Bageshwar, Uttarakhand. Image Courtesy: Rahul Singh Shekhawat

"Then there are X-ray machines but no technicians to operate them. This manpower shortage is severely hampering hospital operations; we are doing our best to manage with the available resources."

Data provided by Uttarakhand's Department of Health and Family Welfare shows that only 1,640 doctors have been appointed against the 2,710 sanctioned posts. With over a thousand vacancies, the burden of providing proper healthcare services has fallen on private clinics, which a majority of the locals can't afford.

While the poor condition of healthcare services is a problem in several states in India, it's exceptionally grave in Uttarakhand, where efforts by successive governments to attract medical practitioners to serve in the hills have failed.

Government's defence

This manpower shortage has forced the state government to run more and more hospitals on the PPP mode. Recently, the first CHC at Doiwala — Chief Minister Trivendra Singh Rawat's constituency — in Dehradun district was handed over to the Himalayan Hospital Trust. Similarly, MoUs to transfer two CHCs in Devprayag as well as the Tehri district hospital to function under the PPP model have been signed. All this indicates that the government believes it can't fill the vacancies alone.

A district hospital in Tehri that the government runs in a PPP mode. Image Courtesy: Rahul Singh Shekhawat

A health centre in the remote Gangolihaat town in Pithauragarh district of Uttarakhand. Image Courtesy: Rahul Singh Shekhawat

Rawat, who also holds the responsibility of the Uttarakhand Department of Health and Family Welfare, claimed that 1,137 doctors had joined since he took charge 17 months ago, as compared to the 1,133 hired in the past 17 years. "At least 17 of the 21 doctor posts in every district hospital have been filled. Also, tele-medicine centres have been started at various government hospitals, and an air ambulance service is being launched," he said.

However, Rawat's claims were backed only by the district hospital in Nainital, where 20 of the 24 vacancies were filled, that too only on a high court order.

Nonetheless, the Uttarakhand government has been trying to mitigate the situation. It has brought in the Transfer Act 2017, which is unique to the hill state. Classifying postings in two areas, sugam (accessible) and durgam (remote), the Act stipulates the mandatory transfer of those posted in sugam areas for more than four years to durgam areas. But it remains to be seen whether the legislation will succeed in ushering in better healthcare services to the hills.

The author is a Dehradun-based freelance writer and a member of 101Reporters.com

 

 

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Updated Date: Feb 08, 2019 18:11:02 IST

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