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Health knight rules night

- Gimmicky, but chief secy Sajal’s surprise raids bare truancy, mess

A suspension, six transfers and a dozen showcause notices in the span of hours. Jharkhand’s healthcare service personnel woke up on Thursday blinking in disbelief as chief secretary (acting) Sajal Chakraborty cracked the whip at a pace never seen before.

Gimmick or not, for the first time in the history of Jharkhand a chief secretary gave up his night’s sleep to raid five state health service centres in Ormanjhi, Ramgarh, Patratu, Kanke and Namkum. The Telegraph team accompanied Chakraborty on the intervening night between Wednesday and Thursday from 9pm to 3.30am to watch him in action.

The irony was that even after his announcement on Wednesday morning at a DC office meeting about his surprise inspection, community health centres took it lightly.

Keeping the management of capital-based RIMS and Sadar Hospital guessing when the first whiplash would fall, Chakraborty’s vehicle crossed city limits by 9.30pm. It was clear the acting chief secretary would start with centres on capital outskirts. Dr Sumant Mishra, director-in-chief of health services, accompanied him on the inspections.

At Ormanjhi community health centre, when the team reached at 10pm, Chakraborty noted down a number of problem areas.

There was no signage on NH-33 to help people to locate the health centre. Patient-doctor ratio was uneven, with an average of eight doctors per 40 patients a day. On an average, 90 deliveries were seen per month and yet there was no gynaecologist at the centre. Also, general nurse-midwives (GNMs) and sahiyyas were not seen with new mothers at night. Most distressing, any night emergency case is directed to RIMS in Ranchi, 30km away from where the Ormanjhi centre was.

At 11.10pm, Team Chakraborty was at Ramgarh upgraded sadar hospital, where a beaming welcome raised suspicion that news of the raid had leaked out.

Still, glaring lapses stood out. Though it was a sadar hospital along the highway (NH-33) and it was mandatory to have an anaesthetist, surgeon, gynaecologist and paediatrician each, the facility only had eight general doctors. Only a sahiyya was seen, though 10 deliveries had taken place on Wednesday. And just like the Ormanjhi centre, the hospital had no signboard on its approach road.

Twenty minutes past midnight on Thursday, Chakraborty was at Patratu community health centre (also called the first referral unit or FRU), which ironically referred all emergency cases to RIMS, 50km away from the area.

Though every first referral unit needs to have a blood bank, it was absent here. It was left to Dr Mishra to question how it “became a FRU without a blood bank”.

The unit based lack of proper food arrangements for in-patients, when according to norms, each was entitled to meals of Rs 50 per day. Even the log register was not maintained well, so discharge timings for new mothers — ideally supposed to stay for 48 hours after delivery and dropped home on a Mamta Vahan — were hazy.

On the way back to Ranchi, at Kanke community health centre, 15km from RIMS, where Team Chakraborty reached at 1.48am, the doctor, one Geeta Kumari was found playing truant. Her suspension has since been ordered.

In Kanke, other shockers were found. The attendance register had signature mismatch. A woman patient was found admitted to a male ward. Three ambulances idled as drivers were not on duty. There were only three patient admissions in the past six days, though medical official in-charge Md Ahsan claimed “30-35”.

The last stop, Namkum community health centre, at 3am, revealed no ambulance. But it was the only centre where patient count, including OPD and admissions, was satisfactory, with 30 to 40 arrivals a day at the OPD and 100 deliveries a month. This was the only centre where gynaecologist Kiran Chandel was present at 3am.

Inspection over, Chakraborty told The Telegraph: “Action will be taken from top to bottom. Without naming names, I’d like to say officials who have owned up responsibility to check facilities that are inactive will actually understand and act accordingly.”

Chakraborty added Dr Mishra would be directed to release a note for every community health centre on its dos and don’ts. “Whether centres comply or not will be checked via surprise inspections,” he said.

He also advocated strongly for every health centre to install a signage or billboard on its approach road. “Health centres must have directions to let people to know about them,” he said. Also, doctors “uncomfortable with infrastructure” should speak up, Chakraborty added.