When healthcare proves fatal: Botched up medical camps

An eye check-up and a cataract surgery camp in Barwani, Madhya Pradesh created a lot of furor after the patients complained of disturbed vision following the operation. Around 30-35 people took part in the camp held during November 16 to 24. Soon, reports began to flood in from patients complaining of irritation and blurred vision resulting from infection. 32 patients are currently facing possible vision loss.

"When their condition deteriorated and were referred to another ophthalmologist, it was revealed that they were on the brink of losing their eyesight," said Sharad Pandit, the joint director of health in Indore, who ordered an inquiry into the matter. "It is unfortunate that this happened at a government camp."

Around the same time, Dr Charanjit Singh of charitable society 'Sarv Kalyan Sewarth Samithi' conducted yet another eye check-up camp in Ambala, Haryana. He charged Rs 6,000 to Rs 10,000 from each of the patients who underwent cataract removal surgery in the congested Mahesh Nagar locality on November 24. Of them, 15 patients soon developed infection in their eyes.

They were later admitted to Chandigarh's Post Graduate Institute of Medical Education and Research (PGIMER), where 11 have received complete treatment, while one is in critical condition and stares at blindness.

Dr VK Gupta, a civil surgeon in Ambala, filed a case against Dr Charanjit alleging that he did not have the required permission to conduct the charitable eye camp. The callous attitude of the management and the unhygienic conditions are the main reasons behind the debacle.

Botched up surgeries are definitely very common in India, especially in the medical camps conducted in rural areas and city outskirts which are far from district hospitals. While medical camps like these bring healthcare to those who cannot afford the traveling cost of going to hospitals situated far away, the possible negative effects far outweigh the positives.

Around the same time last year, in a horrific incident, a government-run mass sterilization camp in Chattisgarh's Bilaspur district went haywire and resulted in the death of 15 women. Of the 83 women who underwent laparoscopic tubectomies, over 50 were hospitalized with 25 in critical conditions.

Government directives allow a maximum number of 30 operations in a camp in a single day. It's not uncommon for districts to receive 15,000 operation cases in a year. Usually there is just one team with one lacroscopic surgeon to carry out this work. The target is divided amongst the different health centres, who then proceed to outdo each other in conducting medical camps, not taking into account that there is usually just one surgeon to carry out all the procedures.

While trying to manage all the cases, the surgeon hops from one camp to the other, and is forced to cross the 30-case limit. Moreover, the hospitals receive just the period of October to February to hold the camps.

In Bilaspur, just one doctor, Dr RK Gupta, though considered an expert in such cases, conducted a staggering 83 operations with one instrument within five hours.

Barely any patient is aware of the possibility of HIV infection which can be caused by the surgical instruments being used repetitively without being properly desensitized. The antiseptic solution used to 'sanitise' the instruments is basically just an eye-wash. Moreover, the instruments spend hardly around 2-3 minutes in the solution, which is not strong enough to kill the HIV, even if it used for an entire day.

Moreover, this camp too violated the government regulations and underscored the need of performing such surgeries in "established healthcare facilities". This camp was carried out in an almost abandoned private charitable hospital in Pendri village.

A health-worker informed that just one room was opened at the hospital and all the women were made to lie down on the floor for the surgeries.

The very next day even as several women who got infected from the surgeries performed in this camp were getting admitted to hospitals for proper treatment, in another hospital in Bilaspur, 26 tubectomies were carried out in an hour in another sterilization camp by the government; amounting to one surgery every two minutes.

In rural areas, Community Health Centers (CHC) are the designated hospitals, which have very few beds. Routine patients take up most of these beds and even resort to lying in the spaces between the beds. As such, if any surgical camp is carried out here, there can never be enough beds for the patients.

Due to this issue, in a mass sterilization programme carried out in Malda, West Bengal, in February 2013, around 100 women were dumped unconscious in a nearby field as the hospital could not accommodate more than 30 women.

The hospital could not even provide ambulance services, and as one woman was being taken home on a cycle van after the operation, it collided with a matador, resulting in grave injuries.

In December last year, soon after the fiasco in Bisalpur, an eye camp organised by an NGO in Gurdaspur district in Punjab, under "severe unhygienic condition" caused permanent damage to the eyesight of all the 60 patients.

The health ministry, in an answer to a parliamentary question two years ago, had stated that between 2009 and 2012, the government had paid compensation for 568 sterilisation-caused deaths.

Sterilisation camps are carried out regularly in India to control its booming population, and the government provides cars and electrical goods, along with money, as incentives to women who volunteer to undergo this operation.

Moreover, certain quotas and incentives are also offered to the doctors, which cause them to rush procedures. The medicines in the public health sector are also frequently found to be out of date or of poor quality. Corruption is so widespread in this sector that even basics such as disinfectant are watered down to save money.

Sterilization camps always see young mothers come for the surgery with infants and young children tagging along, who face a high risk of exposure to infection and diseases. Additionally, the children, along with mother-in-laws and other family members who accompany the young women substantially increase the floating population of the camp. As the hospitals get only a limited staff to take care of the entire cleaning processes, including OT hygiene and the toilets, sanitation becomes a big issue with a greater number of people.

Since laproscopy requires patients to be on an empty stomach, most women spend the entire day without food, as they reach early to get a place in the day's limited number of operations. This results in many of them going into hypotension or low blood pressure.

The undue pressure these camps create on the hospital's one or two attending doctors is a major reason for the numerous fiascos. India is one of the few countries in the world where pre and post-operative cares, checking blood pressure, and taking pathological tests are all carried out by a doctor instead of a nurse. The hospital doctors are also expected to take care of paperwork and emergency cases among other regular work.

These issues need to be taken care of, especially by the public health service. Medical camps are in dire need of more health care personnel and better sanitation. Work needs to be done to stop the inherent corrupt practices and better funding needs to be provided to the CHCs and such medical camps.

Bisalpur sterilisation camp: https://www.youtube.com/watch?v=Wl_TRo0RXgk