Patients at Patna Medical College and Hospital. Picture by Ranjeet Kumar Dey

Patna Medical College and Hospital gets hundreds of cases everyday from smaller healthcare facilities but what has become a matter of concern is that most of these referrals are minor ailments.

The biggest state-run health hub — Patna Medical College and Hospital (PMCH) — has become a sort of referral hospital. Doctors claim primary health centres, additional primary health centres and even sadar hospitals refer cases like influenza or removal of wax from people’s ears to the health hub.

Swamped with minor cases, the health hub is unable to concentrate its resources in providing quality healthcare to people.

V.P. Sinha, physician, PMCH, said: “Everyday, we get around 800 cases at the outpatient department, which are referred from the smaller healthcare facilities. Around 70 per cent of these cases are related to ailments such as influenza, fever, stomachache and acidity. I do not understand why doctors at primary health centres cannot treat such patients? Why do they refer such simple cases to the PMCH?”

He added: “I don’t know if the doctors at smaller hospitals lack infrastructure or confidence, but they continue with the culture of referring every case to the PMCH. If we remain burdened with such cases, we would never be able to give quality service to the people.”

Examples of the minor cases that doctors at the PMCH have to deal with are aplenty.

S.S. Prasad, head of the ophthalmology department at the PMCH, said: “You can imagine the situation when I get cases referred by hospitals in far-off villages and patients come with the problem that something has gone into their eyes. A week ago, a six-year-old boy came to us from a primary health centre in Maner. He had been hit in the eye with a ball. The doctor in the village could not remove the foreign particle from his eye, which is a very simple procedure.”

He added: “The doctor could have detected the foreign material with the an ophthalmoscope and s/he could have easily removed the foreign material. But the doctor chose to refer the patient to us.”

The PMCH gets around 300 such cases every month.

Even removal of earwax and something as regular as childbirth is also often referred to the PMCH.

A doctor at the gynaecology department of the PMCH said: “Around 15-20 cases of normal delivery are referred to us from the primary health centres. Asha workers are supposed to assist doctors during normal delivery. I cannot understand why such cases are also referred to the PMCH.”

The grass, however, is no greener on the side of the smaller healthcare facilities, where there is hardly any infrastructure. Forget an ophthalmoscope, some of them do not even have an X-ray machine.

Bihar Health Services Association spokesperson Ranjit Kumar, who also works at a primary health centre in Koilwar, Bhojpur, said: “At my centre, the X-ray machine has been defunct for months. There is no CT scan or ultrasound machines either. If we don’t have even such facilities, what can be expected of us?”

He added: “We are helpless and have to refer patients to the PMCH.”

Deepak Kumar Singh, a doctor at a primary health centre in Begusarai, said when the CT scan machine at the PMCH was operated on a public-private partnership mode, how could smaller centres expect to own such an instrument?

He said: “We are helpless even when an asthma patient comes to our centre.

“We do not even have an oxygen cylinder or a proper operation theatre. We are provided with two medicines — an antibiotic and a cough syrup. The state government has promised a lot but provided nothing.”

Too much to handle

Concern

Large number of minor cases referred to PMCH everyday from smaller healthcare facilities like primary health centres, additional primary health centres and sadar hospitals

Ground reality

Outpatient department gets around 800 cases everyday, 70 per cent of which are referred from smaller health hubs

Simples cases such influenza, fever, pain in stomach, acidity and removing earwax

Delivery of babies, which can be performed at primary health centres, with help of doctors and Asha workers are also referred to PMCH

Result

PMCH swamped with minor cases with serious patients suffering

Doctorspeak

“I don’t know whether doctors at smaller hospitals lack infrastructure or confidence, but they continue with the culture of referring every case to PMCH. If we remain burdened with such cases, we would never be able to give quality service to people” VP Sinha, physician, Patna Medical College and Hospital

Other side

“At my primary health centre, the X-ray machine is defunct for months. There is no CT scan facility and ultrasound machine. If basic facilities are not provided to us, what can be expected from us? We cannot diagnose patients even for minor ailments and are forced to refer them to the PMCH”

Ranjit Kumar, spokesperson of Bihar Health Services Association and associated with Koilwar primary health centre