Why Delhi Government’s Plan To Remodel And Upgrade Some Hospitals Is An Important Intervention

The vacant plot of land that connects Lok Nayak Hospital and Govind Ballabh Pant Hospital on New Delhi’s Jawahar Lal Nehru Road is where the ordinary man takes a moment to rest and reflect on his ailment or that of a dear one. He, like others sitting around him, is here, either to himself seek relief and cure from a disease, or is accompanying a dear one for treatment.

The story of the ordinary man's medical needs and related struggles in general, and that of the his reliance on medical facilities available at Delhi government hospitals in particular, begins to unfold here.

He holds on to patience, decent amounts of it — required massively when it comes to waiting for an appointment, or for keeping track of the progression in treatment or admission process. Government-run hospitals, including those run by the Delhi government, are sometimes the last destination in his hope to lead a disease-free life.

Despite a complicated set of difficulties most patients and relatives face in reaching these hospitals from their homes and hometowns, or from the hospitals they are referred from, these folks prefer to seek medical intervention in government-run hospitals in Delhi (including hospitals run by the Delhi government). Trust and affordability are two major factors that play out in the crucial hours of the event.

It was through word of mouth that Usman Ahmed (name changed), a daily labourer from a village in Bijnor, got to know about Lok Nayak Hospital, Delhi. He, along with his wife and a few relatives was in Delhi for the treatment for Husna, his daughter, 9.

Husna, according to Ahmed, is a child with special needs, and it comes with some complications he is not aware of. He has brought Husna to Delhi for some medical investigations. “Her weight is a cause of concern. I had taken her to PGI (Postgraduate Institute of Medical Education and Research, Chandigarh). So far, I have got two tests done for her. There are three more to go.” He has not decided how and where he and his family would spend the night in the event of rains. There is no shelter, but he is fine with it.

What has brought him to Delhi for tests and medical investigations that possibly could have been done in Meerut itself? Usman Ahmed says, “To be very honest, we feel a bit scared. We don't know anyone here. But we know of someone from our village who was suffering from ‘kaali peelia’ (as Hepatitis B and C are known in rural parlance). His health improved tremendously. He advised us to visit Lok Nayak Hospital, Delhi. This suits us.” He hopes that he is as lucky as the relative who got cured of ‘kaali peelia’ at the government hospital.

At a distance, two men from Janakpuri (they did not wish to be named) are contemplating on the next indication from the hospital staff. Their male relative, in his early 50s, is fighting a kidney ailment. They are fighting fear and some anger within. One of them opens up. He says, “We brought our relative here, who is in his fifties, to the emergency ward. He is suffering from a kidney ailment. Ward boys were not free and we had to pull the patient on the stretcher to the other building. It was exhausting. Then, a doctor refused to attend to a needle on the patient's hand.”

According to him, blood was required for the patient. But he could not figure out how to arrange for it. He says, “They (the hospital staff) are not telling us the blood group of the patient. They are asking us to bring two donors regardless of the blood group, and saying that once we bring these donors, the hospital will provide us two bottles. Why? We can simply go to the blood bank and arrange for two bottles. Government hospitals are for people like us and for the care of patients. Bad state of affairs.”

Having been referred to this particular hospital from Deen Dayal Upadhyay Hospital in Delhi’s Janakpuri area, the patient's relatives preferred a specialty hospital in the same locality, but they were instead referred to the hospital at JN Marg. He adds, “It was tough for us to bring him here from Janakpuri, but there was no choice.”

Between reams and rounds of formalities surrounding check-up and other appointments, which have come to an end after they received a slip for a check-up slot scheduled for a distant 2020, relatives of Zarina (who goes with her first name) are wondering when to start for Bharuch, Gujarat. “Inhe heart ki TB hai,” one of her relatives says.

She pulls out some papers from a plastic bag. “We have been told that the tests we got done for her in Bharuch are not sufficient. So, we need to get more tests done for her. We have to wait till 2020.” Will they wait until then? “She has been suffering for two years. We would like to bring her back — if she is able to sustain it.”

Looking at the need to improve healthcare in hospitals run by it, and patients’ growing needs, the Delhi government, as reported recently, is all set to remodel 15 hospitals. The upgrading and remodeling work, as per an official who is not authorised to provide details, is a result of a lot of work and observations done in the past years by the state government. Higher authorities in the health ministry could not be reached for comment.

Plans are in place and implementation, as per doctors, is round the corner. The plan to expand the number of beds from 100 to 700 or 900 (and even a higher number of beds against the existing number in some hospitals).

The remodelling work is aimed at ensuring better healthcare for patients and prevent over crowding. The multi-pronged approach includes upgrading hospitals with modern equipment, bringing operation theatres and intensive care units in dedicated wings at the hospitals, and to bring down the referring of patients from one hospital to another.

Among the hospitals that fall under the plan are Babu Jagjivan Ram Memorial Hospital, Lok Nayak Jaya Prakash Hospital, GB Pant Hospital, Bhagwan Mahavir Hospital, Ambedkar Hospital, and Lal Bahadur Shastri Hospital.

According to a doctor serving at a government hospital in north west Delhi (he doesn't want to be named), the incoming numbers to the casualty section to their hospital (100-130 bedded) “is heavy” - nearly 1,200-1,500 per day. The doctor says, “OPD is nearly 2,000 per day and above. The inflow is huge. In other Delhi government hospitals, this number could be bigger. Most people coming in are those who cannot go to private hospitals due to affordability concerns. Every patient has to be attended to. Every patient has to be given medicines. The OPD keeps going on. There are times when the OPD is operating even beyond its timings. There are patients at the counter. The staff pitch in beyond duty hours.”

The upgrade is expected to bring in a change in the patient-relative-doctor scenario that tends to get stressful at times, even turning violent on occasions. As per a doctor who doesn't want to be named, “in today's times, the patient is not a problem for the doctor.” He says, “We can tackle the patient, but convincing the relative is very difficult. Ladne marne to taiyyar rehte hain us wajah se doctors thhoda ghabraaye hue rehte hain (the relatives of the patient are ready to turn violent, doctors are slightly scared because of that,” he adds.

Considering the fact that there are nearly 3,000-4,000 patients per day coming to the hospital, there is also some room for dissatisfaction and complaints among the patients. “Jo shikayat karta hai usko zyada tavajjo log dete hain aaj ki date mein, especially the media (the media tends to keeping playing that one complaint). They will not hear those 3,999 or 2,999 people who have been attended to. Instead, they will go to that one person who has a complaint," the doctor adds.

When implemented, this plan will bring better medical facilities and less stressful days for patients and relatives, who mostly struggle on account of being referred from one hospital to another. Currently, as per patients, most of them are referred to another hospital owing to unavailability of the specialty or other facilities in the hospital that first attends to the patient.

As per interactions with patients and relatives in government-run hospitals in Delhi, when the referring is done from a hospital in another state to a hospital in Delhi, the patient and his relatives ride on hope and make it to the destination hospital with some amount of mental and emotional energy.

It cushions them against the unexpected and the unfamiliar at hospitals. Whereas, when the same patient and his relatives are referred from one Delhi hospital to another, the energy and emotional preparation depletes.

Three patients, all saying they were suffering from Hepatitis C, were resting on the vacant plot of land that lies between GB Pant Hospital and Lok Nayak Jayprakash Hospital. They were here between decisions to make regarding their stay in Delhi for treatment, or for their appointments to progress.

One of them said that for them, Delhi is synonymous with inconvenience. But there is no choice — other than coming to a government-run hospital in the capital city owing to lack of facilities in their hometown. “We do not like coming to Delhi. Sivaye pareshani ke kuchh nahin. They make at least 50 papers. The relatives become patients themselves going through these inconveniences, but we have no choice. What should we do?,” said one patient. They were preparing to spend the night in the open.

In such cases, it becomes slightly easier for the relatives of a patient who hails from Delhi, than it is for a patient who comes from outside Delhi to manage time, resources, space and mental preparation.

According to an official in a hospital in Jahangirpuri, that comes under the Delhi government, currently, there are 100 beds in the hospital. “As of now, we increase the number of beds inside the building itself from 100 to 130.” Our proposal is for 900 additional beds. A new building will come up. It is in the planning stages. It will be close to the building. On the other side of the existing building. A total 900-bedded hospital will come up. There will be all multi specialties, super specialisation, and an ICU facility.”

The hospital, as per a doctor at the government hospital, meets the needs, largely for people of the locality, yet there are times when the inflow of patients is heavy. The hospital staff make efforts to meet the growing inflow, and the awaited upgrade will provide the much-needed boost in their efforts.”

"This hospital started as a dispensary, then a polyclinic and then developed into a 100- bedded hospital. But we keep around 130 beds. In the gynaecology and paediatrics sections, there are too many patients. There are around 15 beds for observation in the casualty section. Once the buildings are ready, the situation will be much better," he adds.

The onus of progress in the implementation stages will be on the Delhi Public Works Department.

How much time will the new set up take to fall in place? “It all depends on the completion of the building work. PWD will be carrying it out,” he says. According to a doctor at one of the hospitals that come under the Delhi government, the work will start as soon as the new building is handed over to them. He says, “First, the building will be made. Everything from the existing building will be shifted there.”

The new set up is expected to bring this hospital “around 15-20 operation theatres. dialyses will be part of it.” The new set up, as expected, would help people like Vineet Kumar, a youth who was waiting at Lok Nayak Hospital where he had rushed his sister for a treatment for a “stomach-related infection” the same afternoon.

He said, “We are from Jahangirpuri, and I had to shell out Rs 1,500 just for a private ambulance to bring her here.” Once the convergence of the building structure with more beds, facilities and modern equipment takes place, patients, it is expected, will not be referred to other hospitals to make the best of time during the crucial hours, and treatment facilities.

Lok Nayak Jayprakash Hospital is looking at an ambitious transformation. “Things are at the cabinet level and PWD level currently." According to a doctor at this hospital, maternity, child and medicine blocks are among the priorities in the new plan.

Talking over the phone, he said, “Along with basement, the new structure will be a 23-storey facility. It will consist of 200 ICUs, 25 operation theatres, and additional beds. Medical emergency ward will be remodelled — up to seven storeys. This building is old. Beds have to be increased. There will be 500 beds (150 will be added to the existing count). The ICUs and OTs will all come to one place. Now, a tender will be floated. First, the casualty building will be remodelled. ICUs will converge at one place. the number of OTs will go up.”