Once Pune's hospital no. 1, now apathy ails Sassoon

PUNE: Usually busy Monday morning at Sassoon General hospital was a lot busier last week. Apart from patients, a battery of workers milled around, opening cupboards and pulling out files, stacking them in huge bags and piling them on the hospital's staircase. It wasn't a spring cleaning exercise, but one the hospital undertakes once in five years - of discarding old patient records.The massive exercise notwithstanding, the record room on the hospital's top floor still has files kissing the roof, the paper trail building by the minute from the ground floor that has patients streaming in every second for treatment in this hospital that doesn't close its doors on anybody; where the crowding ensures that while service is delivered, it is after a long and frustrating wait.
More patients walk into Sassoon in 24 hours than the number of minutes in each day. People come not only from Pune district but from across the state for treatment as routine as a family planning operation to a complicated neuro-surgery. Ambulances bring in patients to the hospital foyer every few minutes, key diagnostic labs work round-the-clock and resident doctors put in 15-hour shifts. Nurses follow shift timings with clockwork precision.
This state-run hospital, attached to the BJ Medical College, has a system in place, but a crumbling infrastructure. A clutch of healthcare professionals here manage thousands of patients, and equipment that can cater to tens is burdened with hundreds. In this melee, doctors also have to dole out fitness certificates for Amarnath yatra and issue disability certificates.
Connecting patients here across floors and wards is a common complaint - delayed care. Families of patients crowd the hospital, spending nights in dreary, littered corridors where there are no benches, no fans and in some parts, no lights.
Bumpy road to treatment
It took Anita Uke 16 years, an 800-km journey and a letter from chief minister Devendra Fadnavis to get treatment for a crippling injury she had suffered when she fell from the terrace in her village Lakhni in Bhandara. She was 18 then, had no family and was dependent on neighbours for food and help. The doctors she visited gave her little hope for recovery. She underwent two surgeries in government hospitals in Nagpur, but didn't recover. So when the CM visited Lakhni recently, a few villagers approached him for help and he gave them a letter recommending treatment in Sassoon General Hospital.
Uke, now 34, underwent a hip replacement surgery and is recuperating in the hospital's general ward.
But Uke's case is an aberration. Ramesh Kani, 32, has been waiting for his abdominal surgery for about two months, his life and that of his family on hold since then. Take Tukaram Velhekar, who came from Baramati for a valve replacement surgery. "He was taken to the operation theatre a few times, but was not operated upon. He used to cry and left the hospital one day without informing anybody," said a patient awaiting the same surgery.
Officials said patients tend to stretch facts, unable to understand medical reasons. "On many occasions, patients have high blood sugar or their blood pressure needs to be stabilized. Patients do not understand this and think they have been made to wait unnecessarily," said pathologist Deepak Kulkarni, medical superintendent of the hospital.
Patience often runs thin among many patients and firefighting is a core skill among employees here. Sassoon's handling of the H1N1 outbreak in 2009 or the German Bakery blast victims a year later is considered a feat, but then a crisis breaks out every few hours here.
Last week, Vinod Gupta, a security guard in need of a joint replacement surgery, came from Nigdi at sharp 9 am for a CT scan and so did a family from Osmanabad with their HIV positive son who had suffered a paralytic stroke in March. Seven hours later, they were still waiting, as the air conditioner in the hospital's only CT scan unit - that handles around 60 cases a day - broke down in the soaring Pune heat.
When the air conditioner issue was sorted and the CT scan queue started to clear, the queue outside the x-ray unit began to build as the only digital x-ray machine developed a snag. The machine stirred back to life 24 hours later.
At the dialysis section, two of the five units have been out of order, but 15 to 16 cases are handled here every day.
The hospital's cath lab was non-functional for almost two years, when the number of angiographies dropped from around 300 to just 52.
It's not only the equipment, but the mounting cases that ensure a crisis is just around the corner. At the hospital entrance, assistant sub inspector Suresh Kale makes copious notes of each medico-legal case (MLC) in his register that's filling fast. His 12-hour shift ends at 9pm, but his day seems far from over, his hands full with a dead body (suspicious death), a two-wheeler accident case, a man injured in an altercation among cases.
"The hospital gets 47,000 MLCs and 6,000 post-mortem cases annually. These duties are a burden for doctors who are more interested in clinical work. They are constantly afraid that the smallest mistake could cost them their jobs or land them in legal trouble," said a resident doctor.
This load is unlikely to lift any time soon. State medical and technical education minister Vinod Tawde said that all cases, particularly of murder and rape from western Maharashtra come to Sassoon as courts lean heavily on medical reports issued by here.
Do it yourself
Santosh Kakirte, a slum dweller from Yerawada, is not a paramedic, but knows where to get the stretcher from, how to put his ailing father on it and take him for his checks and diagnostic tests around the hospital premises, holding his saline bottle. "Attendants are not available during peak hours," he said.
There are no attendants, really, at all hours and the few around grudge their workload. "I have been working here for the last 16 years, but have not been made permanent yet. There are so many posts lying vacant. How can we be expected to serve all the patients?" said Pramod Rokde, who is among the 88 temporary ward attendants at the 1,296-bedded hospital.
Patients' attendants are often lost in this maze of a mammoth healthcare institution as they wheel around their loved ones from one diagnostic facility to another.
Last Tuesday night, relatives of a man with a heart condition and a broken rib went about the diagnostic checklist, first rushing him for an x-ray, and then for an ECG, which they just couldn't locate. By the time they did, the ECG unit was closed.
Most patients don't complain, but a few give up. A young web designing student from Bibwewadi went around the hospital tracking the scattered room numbers, her mother limping behind her. By late evening the mother-daughter duo decided to take discharge, and not because of the hassle. "My mother is HIV positive and the hospital is so dirty. The bed sheets in the ward are unclean. We can't take this risk as she has poor immunity," the daughter said.
Last fiscal, of the Rs 91.89 crore budget for the hospital, only Rs 14 lakh was earmarked for the hospital's repair and maintenance. The lion's share of Rs 71.89 crore went towards staff salaries. Apathy of attendants and visitors who spit around or litter the corridor where they eat and sleep only adds to the poor upkeep.
But tucked in one corner of the hospital is a special ward, an oasis of eight private rooms, that have a bed even for the attendant. The bed linen here is washed every alternate day, and table covers every Monday. There is a fresh smell to this ward unlike the rest of the hospital where the strong disinfectant smell permeates both clothing and lungs of people who visit it. Bank employee D Kale from Buldhana district waited four days in the general ward before he got admission here. He said he was pleased with the treatment, and possibly also the price. The daily tariff for the special rooms is Rs 150 - a formula the hospital could apply to more beds for better service, said patients.
Officials admit the load is affecting the quality of care. "Patient load is in excess of what the infrastructure can handle and the quality of care is bound to get affected. We need to strengthen our public healthcare units. Upgrading Sassoon and bringing it on par with AIIMS-like institutes is the need of the hour," said Dr Ajay Chandanwale, spine surgeon and hospital dean.
Sands of time
In the old Sassoon dagadi (stone) building, embedded on a wall is its history - built in 1867 with a generous donation of over Rs 2 lakh that Jewish philanthropist David Sassoon made for the "poor of Poona". However, in the years following its inception, industrialists, countless Puneites from across socio-economic strata and even national leaders (Mahatma Gandhi underwent an appendix surgery in 1924) sought treatment here.
In the first 100 years of its existence, it was the hospital of many firsts - the first cath lab in Pune came up here and it got a ventilator in 1967. It started performing heart surgeries in 1970. Patients handpicked Sassoon to get treated. Dr Rajeev Joshi, a BJ Medical College alumnus, recalls admitting his mother to the hospital in the early 80's when she complained of abdominal pain and later even himself when he fractured his hand as it was "the best hospital in Pune city".
His batchmate Dr Prachee Sathe, who now heads the critical care unit at Ruby Hall Clinic, recalls the honorary doctor system that worked well with premier doctors visiting Sassoon once a week for OPD, teaching students and seeing patients.
Old timers recall Sassoon hospital's glorious phase as its centenary year of 1967. "Everybody was invested in highlighting all that was good," recalled chest surgeon Dr Bankim Amin, adding that in the 1970s, the best surgeons would operate in Sassoon and not in private hospitals. His son was born in Sassoon, a hospital where technology came before any private healthcare facility, he said.
Prosperity has led to patients seeking private healthcare, said family physician Dr Kumar Mandhre, also a BJ alumnus. He said the number of middle class and lower middle class people was large in the Eighties and Nineties, but now everybody wants to seek the best possible healthcare money can buy.
Sassoon remains a preferred healthcare destination even now, but largely among the poor and their preference for this hospital is rooted in need. "We get patients who first approach private hospitals and come here when they exhaust all their money," said Malasiddha Shelke, a senior social worker at the hospital.
Ill-equipped healthcare facilities across the state refer patients to Sassoon. "The government hospital in our area referred us here as they said difficult surgeries can be performed here," said Chitra Zadokar, who has come from Akola for a knee replacement surgery. Jalgaon resident Chandrabhaga Patil, 73, handpicked Sassoon for her knee replacement surgery both for affordable treatment and also because the private and government doctors she consulted directed her to this hospital.
For those on their way back home from the hospital, the hardship is history. Nine months pregnant Pooja Ganesh Kadam, 20, was admitted to Sassoon in mid-April with a heart condition. Last week, she sat in the dust-layered corridor with her mother and brother who had camped there for 11 days. "I had a normal delivery," she smiled, cradling her newborn, oblivious to the filth, her sense of relief an omitted detail in her case file now stacked in the record room for the next five years.