Chhattisgarh ground report: Filthy OT, toilets in nearby zoo made sterilisation camp fatal

Were the deaths at the sterilisation camp in Bilaspur a mishap waiting to happen? The government has been prompt in suspending and registering cases against the doctors involved, but the medical fraternity here believes there’s more than what meets the eye. The doctor who performed the actual surgery is close to his age of retirement and an experienced hand. In fact, not long ago he had received an award from the state’s health minister for successfully conducting nearly one lakh such operations without minimal accident.

Moreover, the fact that deaths in such a large number took place at the camp does not reveal much about chances of lapses at the stage of the procedure of the surgery. A rapidly growing consensus in the medical fraternity points fingers to the factors that were common to all patients in the camp.

What the doctors’ community find frustrating is that the government is showing no inclination to look into the role of the possibly spurious or low-quality drug or medicines used in the camp. “This, if done, would lead them to the corporation that the state government created as a single window solution for the procurement and supply of medicines and hospitals in the state,” says a senior office-bearer of the Indian Medical Association in the state. The condition under which the camps are held to achieve impossible targets makes the mishap appear not as an accident.

Here are six pointers that reveal that the tragedy was in the making:

Location:

The camp was organised on the outskirts of Bilaspur in a building that came up with the dubious identity of a hospital in 1980s. No one today explains how the abandoned building with an unused (some say never-used) operation theatre came to be used as the site for this official camp. This is in contravention of government guidelines laid down for such operations. The building was supposed to house a cancer hospital but the hospital never took off. It was lying abandoned for more than a year.

Fumigation:

The space used for surgery was not an operation theatre (OT) in the true sense. As if the use of the abandoned and disused OT was not bad enough, the surgery, according to reports in the media, was conducted on the floor of the building. A normal OT is supposed to undergo an elaborate procedure before it is declared fit for a surgery. Like, the room and the equipments are treated with an antiseptic, kept locked for 24 hrs, a sample check is done and a certificate is issued. These norms are never followed, almost as a rule, in all the camps organised by the health department.

Non-sterilised operation theatre:

There was no restriction for the attendants and the passersby on entering and leaving the place designated as an OT or the ward. This was not unique at all to this camp. In all such camps, including those eye camps that resulted in over 70 people losing their eyesight in the last two years, the attendants and the socially enthusiastic locals going under the label of social workers, are, in fact, encouraged to volunteer as stretcher- bearer and their entry and exit to the OT goes unrestricted. There is no compulsion, generally, of taking off one’s shoes while entering the operative zone.

Drugs and Medicine:

The medicines used in this as well in all other botched camps in the last few years were purchased by a single agency – The Chhattisgarh Medical Services Corporation Ltd (CSMSCL). The corporation was incorporated in October 2010 with the declared aim to procure, test, store and supply all kinds of medicines, sutures and surgical items, equipment and instruments and to ensure its supply to all health care facilities in the state. The principal secretary of the department of health acts as the ex-officio chairman of the corporation. No question so far has been asked of him, or for that matter, anyone from the corporation.

Today the state health department has issued a circular prohibiting use of certain batches of the four drugs that are used in the state hospitals for administering anesthesia. The drugs are Atropine, Xylocaine, Pentazocine and Calmpose. There is no news so far of any question having been raised to the agency procuring these drugs.

Proximity to a Zoo:

The site of the camp building is next to the Kana-Pendari zoo and park maintained by the forest department. The park boasts of the presence of rich flora and fauna. In the absence of enough toilets and other facilities for a large number of attendants and onlookers who had gathered at the camp and who doubled as auxiliary help to the team performing surgery, it was unavoidable to use the park space as toilet. No checks were devised to intercept germs from taking lift to the OT and the wards along with the large number of carriers roaming around.

Impossible target:

The healthcare approach has always remained target-based. The targets are fixed at the beginning of the year and efforts to achieve it are deemed to spread out throughout the year. But it doesn’t happen that way. By the time funds allocation is complete, a few months pass by. The doctors do not exactly mind it as it is next to impossible to hold field camps during the seasons of extreme summer or heavy monsoon. Mobilization of the patients is also hampered in these times.

Generally the cycle starts in September and continues till the end of February. This shrinks the time frame to six months to achieve target designed for one full calendar year. This year the monsoon in this part of the country lasted longer. The Hudhud cyclone helped the season to extend by a few but significant weeks. That understandably must have increased the pressure on the target driven doctors.