The tragic tale of Bihar’s crumbling health infrastructure

• AIIMS Patna chosen as the CoE, upsetting doctors of Covid-dedicated state government hospitals 
• Bihar challenged with alarming Covid mortality rate among doctors, higher than the national average
• The efficiency of Rapid Antigen Testing in doubt, RT-CPR tests recommended 

THD NewsDesk, Patna: The public health system of Bihar is in a state of turmoil and regardless of the tall claims made by the Nitish Kumar government, doctors are relentlessly struggling to keep Covid patients alive. To rub salt on the wounds of doctors working in Bihar’s state-run hospitals, the government chose AIIMS Patna to bestow the title of Centre of Excellence.

Post the coronavirus outbreak in March, the JD-U government in Bihar had nominated the state-run hospital Nalanda Medical College and Hospital (NMCH) as a Covid-dedicated hospital. Later, two more medical colleges were added to the list. Currently, four COVID-19 dedicated hospitals are running in Bihar: 

• NMCH (Patna)
• AIIMS Patna
• Anugraha Narayan Magadh Medical College and Hospital (Gaya)
• Jawaharlal Nehru Medical College and Hospital (Bhagalpur).

The medical professionals who have been working tirelessly in the Covid-dedicated hospitals were complaining of poor health infrastructure, unequipped to manage the soaring Covid-19 cases. The frontline health workers were allegedly handed over poor quality PPE kits which disappointed them further, adding to their misery. 

The decision to overlook decades-old government hospitals such as the PMCH and NMCH and choose the recently established AIIMS Patna instead set the doctors off. 

“The quality of personal protective equipment (PPE) kits which we received was poor. We can’t spend much time in the chamber wearing the PPE because the chambers do not have air conditioning,” said a doctor from PMCH. 

Reflecting on the fragile health system of Bihar’s public hospitals, Dr Sunil Kumar, secretary of the Indian Medical Association (Bihar Chapter) said, “It is shameful that Bihar government could not find its own decades-old medical colleges fit for CoE and it had to designate AIIMS Patna, which came into existence just eight years ago. It is only because the state could not strengthen the infrastructures of these hospitals. The state’s medical colleges have a huge infrastructure gap. There has been minimal improvement in all these years.” 

Defending the state’s decision, Bihar State Health Society director Manoj Kumar said that AIIMS-P was “the natural choice” since it was the sole Covid-dedicated hospital at the time of selection. In compliance with the Centre’s guidelines, only a Covid-dedicated hospital could be chosen as the CoE, and neither IGIMS nor PMCH fulfilled the criterion then. 

The fragile public health system

While highlighting the contribution of Centre-run AIIMS Patna, the state government has not answered the question of why the state hospitals of Bihar are not at par with AIIMS. The fact that top government officials and politicians preferred AIIMS-P over state-aided hospitals for their treatment indicates the lack of proper infrastructure in the latter. 

Though other states could prepare 50-bed facilities, Bihar’s Covid-19 centres failed to do so. One example is Samastipur’s primary health centre (PHC) which has a 15-bed capacity but can not provide other facilities like pulse oscillators and nebulisers. 

Further, the Central team that visited NMCH in July had raised concerns over the preparedness of the hospital in managing severe Covid cases rumoredly.

High Covid mortality rate among doctors 

The latest data released by IMA (Bihar Chapter) indicates the alarming Covid fatality rate among doctors of Bihar, making it the state with the highest death percentage in India.

Vice President, IMA-Bihar Dr Ajay Kumar informed that more than 400 doctors in Bihar have tested positive for COVID-19, especially the elderly medical staff. 

Dr Ajay Kumar said, “We have analysed the data till August 7. By then, Bihar recorded 388 deaths due to COVID-19. 18 among them were doctors who were on duty. This means doctors account for 4.3% of the deaths.The national average for deaths of doctors is just 0.5%,” he said.

Moreover, the hospitals in Bihar are encountering a shortage of doctors and medical staff. Reports suggest that out of 12,000 appointed doctors, only 4,500 doctors are working on-ground. 

The efficiency of Rapid Antigen Testing in doubt

Heeding to the Central team’s recommendations, the state government had increased the rate of testing since late July. In a video conference with PM Modi, Chief Minister Nitish Kumar claimed that till August 8, the government had conducted 75,346 tests in Bihar. However, only 6,100 samples were RT-PCR test which is roughly 8.13% of the total samples. Whereas, rapid antigen kits tested the other 65,000 samples.

ICMR had earlier conveyed its preference for RT-PCR tests as rapid antigen tests are more likely to return a false negative. Wary of this, ICMR had strongly recommended that if a person tests positive through the RAT method, they must be tested again through the RT-PCR technique.

“If a person’s rapid antigen test is negative, when we ask them to come again for an RT-PCR test, most people do not appear. They think because their first test (through antigen kits) report is negative, there is no need to get tested again,” said a district doctor elaborating on the cons of Rapid Antigen tests. 

According to The Wire’s report, the state’s medical staff is neglecting the physical verification of patients in home isolation. Amidst the shortage of medical staff and proper protective gear, Bihar’s public hospitals are struggling to function efficiently. To ensure that patients are receiving adequate treatment, the state government needs to confront the harsh reality of Bihar’s failing public health system. The state-run hospitals and primary health care centres are in a desperate need of proper PPE kits and modern health facilities. Given the grim situation, the Nitish Kumar government needs to rise to the occasion and restore Bihar’s crumbling health system before it ultimately collapses under the weight of surging coronavirus cases.

Source: The Wire