BAD MEDICINE

Fixing what isn’t broken: Why is Udupi’s well-run district hospital getting new private management?

The Karnataka government decided to hand the hospital over to Abu Dhabi businessman BR Shetty but Udupi residents are opposing the move.

On April 24, Hussain Kodibengre and Siraj Ahmed went to the Madras Records Office also known as Tamil Nadu Archives in Chennai. They were looking for records of the Maternity and Children’s Hospital in Udupi, Karnataka. It was an urgent task because the documents could help them in their fight to save the hospital from being taken over by private interests.

The Maternity and Children’s Hospital is the government district hospital in Udupi. In August last year, the Karnataka state government took the decision to hand the hospital over to Abu Dhabi businessman BR Shetty to be managed by him under a public-private-partnership model. The government is leasing the four-acre plot of land on which the hospital stands to Shetty’s BRS Ventures for a “minimum period” of 30 years which may be extended to 60 years on “mutual agreement”. Shetty has promised to turn the current 70-bed hospital into a 400-bedded hospital, of which 200 beds will be reserved for free treatment of people below the poverty line.

Kodibengre and Ahmed are part of a citizens’ group in Udupi that is fighting the decision and has approached the courts. The Judicial Magistrate First Class on April 18 rejected their complaint against the hospital’s handover saying that the citizens’ group has no locus standi to challenge the government’s decision. The citizens’ group then filed a case with the second divisional magistrate court, a matter which is pending now.

The hospital was built in the early 1900s by Udupi resident, founder of Corporation Bank and philanthropist Haji Abdullah. In 1932, Abdullah donated the hospital and adjoining land to the taluka administration, claims the citizens’ group. However, BRS Ventures argued in court that there are no documents showing that Haji Abdullah donated the land. Kodibengre and Ahmed are hoping to find documents to show that Abdullah owned the hospital land to establish the citizens’ group locus standi as complainants.

“We (the family) do not not have any documents related to Haji Abdullah Sahib’s land now,” said Siraj Ahmed, a banker and financial consultant and also Abdullah’s great grandnephew.

Kodibengre, who is the general secretary of Udupi Zilla Muslim Federation, which works for the welfare of poor Muslims, said: “For two days we dug into the records between 1910 to 1935. We could not find a single record about the hospital.”

Citizens of Udupi fighting against the public private partnership for the Maternity and Children's hospital last October. (Photo: Menaka Rao)
Citizens of Udupi fighting against the public private partnership for the Maternity and Children's hospital last October. (Photo: Menaka Rao)

Is change really needed?

Karnataka has a history of public private partnerships for public health but many of these have failed miserably, say public health activists Akhila Vasan and Vijaykumar Seethappa from Karnataka Janaarogya Chaluvali, an organisation of people’s struggle for health rights in Karnataka.

“Once a private entity takes over a public hospital, it brings in its own rules,” said Vasan. “It slowly starts increasing costs and brings in exclusionary criteria. A private hospital always wants (return on) its investments out of the venture. It is not doing this for charity.”

Dr PV Bhandary is a psychiatrist in Udupi who has worked at the district hospital in the past and is part of the citizen’s group fighting the handover.

“We fear that if this model becomes a success (to the point that BRS Ventures starts running the hospital), it will be used everywhere else in the country,” he said.

BRS Ventures' construction site for a 400-bed hospital next to the original district hospital. (Photo: Menaka Rao)
BRS Ventures' construction site for a 400-bed hospital next to the original district hospital. (Photo: Menaka Rao)

The National Health Policy 2017 espouses both partnerships with private companies to deliver healthcare services as well as strategic purchasing of health services from private players, especially in areas where the public health system falls short. But are public healthcare services failing at the Udupi District Maternal and Children Hospital? Does it fit the criterion for such a change in management?

Low maternal mortality

The hospital is clean and seems well run. There was a water shortage in May, but Matron Violet D’Souza insisted that the hospital was cleaned as it always is. D’Souza does not remember the last time a woman in labour died at the hospital. She had heard that one woman died in their hospital about 13 years ago.

In India, 174 women die for every one lakh live births in the country and maternal deaths at district hospitals are not uncommon in other parts of India.

“There have been only two maternal deaths last year in the district,” said Dr Rohini, district health officer in Udupi. This statistic is remarkable considering that the hospital attends to about 200 women in labour every month, according to senior gynaecologist at the hospital Dr Kishori P. That translates to 2,400 women who give birth to children at the district hospital every year. In fact, Udupi has a lowest maternal mortality rate in Karnataka. Half these women undergo C-sections. C-sections are as performed as often at other district hospitals across India for lack of infrastructure and qualified medical staff.

The hospital demonstrated its efficiency in Rekha Naik’s case. The thirty-year-old woman came to the hospital in early May from Padukone village near Kundapura more than 50 km away. She was unable to walk and was carried to the hospital. She was in an advanced stage of pregnancy and suffered from preeclampsia, a high blood pressure condition that can be a fatal. The doctors conducted an emergency C-section and delivered her twin boys.

District hospitals are the largest government hospitals in a district and get referrals from all over the district. Patients are referred to the Udupi hospital from taluka hospitals and primary health centres and sometimes from other districts too.

“We have a higher percentage of C-section deliveries because most of our patients are referred,” said Kishori, referring to the how their these referred patients often have medical complications. “If there is any risk, we conduct a C-section. We do not even want to allow for perinatal deaths.”

The perinatal period is from 22 weeks of pregnancy to seven days after birth of the child.

Vasan said that the low maternal mortality is a sign of robust healthcare and the hallmark of a good district hospital.

The hospital also has a children’s wing with 20 beds and a Nutrition Rehabilitation Centre to treat children with severe acute malnutrition.

Kenchamma (left) is a migrant farm worker from Baghalkot and lives in Udupi's Nitoor slums. Her 18-month-old son Vasant (right) suffers from severe acute malnutrition and is being treated at the Udupi district hospital. (Photo: Menaka Rao)
Kenchamma (left) is a migrant farm worker from Baghalkot and lives in Udupi's Nitoor slums. Her 18-month-old son Vasant (right) suffers from severe acute malnutrition and is being treated at the Udupi district hospital. (Photo: Menaka Rao)

The hospital is also located at the centre of Udupi city and is easily accessible to a large number of people. The rapid urbanisation of Udupi has resulted in a large number of labourers from Odisha, West Bengal and north Karnataka migrating to the temple town. The migrants work in paddy fields, in building construction, in fisheries and other industries. The migrant labourers live in shanties in the city and it is this low-income group that is most dependent on the district hospital for medical and health services. The district hospital refers patients to Manipal’s Kasturba Medical College, a private hospital, if it is unable to handle a case.

When asked if the about the hospital’s current performance, Rohini said, “It is a good hospital.” She refused to comment on the handover.

Doubts about the private partner

Despite the hospital’s good performance, the memorandum of understanding signed by the government and Shetty last year says that the 70-bed hospital is in a “very dilapidated condition”, “acutely insufficient to meet the current demand” and “...as it stands the institution is not in a position to respond to the aspirations and the need of local population.” The memorandum mentions that Shetty approached the government for permission to develop the hospital.

“We admit that the hospital needs some repairs,” said Ahmed. “But that does not mean the hospital should be given away.”

The existing Maternal and Children's Hospital which will be demolished soon. (Photo: Menaka Rao)
The existing Maternal and Children's Hospital which will be demolished soon. (Photo: Menaka Rao)

The hospital staff are worried both about how well the hospital will be run after Shetty’s group takes over and about their own fate. According to agreement with the government, the BRS Ventures will be allowed to hire its own staff to run the hospital. The current staff who are all state government employees will be transferred to other government hospitals across the state.

The MOU states that the hospital will be monitored by a committee consisting of the CEO of Udupi district, the deputy director of health services, the district health officer, the district surgeon and others.

Even though the memorandum of understanding acknowledges that Abdullah donated the hospital land, BRS Ventures’ lawyers say there is no record to show the land was donated.

The only document procured by the group of activists so far is a record of transfer of the land in 1932 from the taluk administration to the erstwhile Madras Presidency. The document lays down the condition that the properties continue to be named Haji Abdullah Dispensary and Haji Budan Lying-in Hospital and that the hospital should “forever” be used to provide free medical aid free of cost. There is still no record that Abdullah owned the hospital and the land.

Document showing transfer of property from the taluk board to the Madras Presidency. Highlighted text shows the conditions laid down during the transfer of the property.
Document showing transfer of property from the taluk board to the Madras Presidency. Highlighted text shows the conditions laid down during the transfer of the property.

Many Udupi residents continue to support Ahmed and Kodibengre in their hunt for evidence of Abdullah owning the property, so that they can use it to prevent the hospital from being handed over to BRS Ventures. Many of these supporters want to keep Haji Abdullah’s legacy alive.

“We are getting donations (to fight the case) from known people and also anonymously,” said Ahmed. “There are people who are born in the hospital, especially at a time when hospitals were scarce.”

A doctor who works at the district hospital but did not want to be named said: “If the hospital is run in the right spirit, the handing over of the property to Shetty will work. But, this is a good running system. Why do you want to burn your hands? Why kill a running system?”

This reporting project has been made possible partly by funding from New Venture Fund for Communications.

We welcome your comments at letters@scroll.in.
Sponsored Content BY 

What’s the difference between ‘a’ washing machine and a ‘great’ washing machine?

The right machine can save water, power consumption, time, energy and your clothes from damage.

In 2010, Hans Rosling, a Swedish statistician, convinced a room full of people that the washing machine was the greatest invention of the industrial revolution. In the TED talk delivered by him, he illuminates how the washing machine freed women from doing hours of labour intensive laundry, giving them the time to read books and eventually join the labour force. Rosling’s argument rings true even today as it is difficult to deny the significance of the washing machine in our everyday lives.

For many households, buying a washing machine is a sizable investment. Oddly, buyers underestimate the importance of the decision-making process while buying one and don’t research the purchase as much as they would for a television or refrigerator. Most buyers limit their buying criteria to type, size and price of the washing machine.

Visible technological advancements can be seen all around us, making it fair to expect a lot more from household appliances, especially washing machines. Here are a few features to expect and look out for before investing in a washing machine:

Cover your basics

Do you wash your towels every day? How frequently do you do your laundry? Are you okay with a bit of manual intervention during the wash cycle? These questions will help filter the basic type of washing machine you need. The semi-automatics require manual intervention to move clothes from the washing tub to the drying tub and are priced lower than a fully-automatic. A fully-automatic comes in two types: front load and top load. Front loading machines use less water by rotating the inner drum and using gravity to move the clothes through water.

Size matters

The size or the capacity of the machine is directly proportional to the consumption of electricity. The right machine capacity depends on the daily requirement of the household. For instance, for couples or individuals, a 6kg capacity would be adequate whereas a family of four might need an 8 kg or bigger capacity for their laundry needs. This is an important factor to consider since the wrong decision can consume an unnecessary amount of electricity.

Machine intelligence that helps save time

In situations when time works against you and your laundry, features of a well-designed washing machine can come to rescue. There are programmes for urgent laundry needs that provide clean laundry in a super quick 15 to 30 minutes’ cycle; a time delay feature that can assist you to start the laundry at a desired time etc. Many of these features dispel the notion that longer wash cycles mean cleaner clothes. In fact, some washing machines come with pre-activated wash cycles that offer shortest wash cycles across all programmes without compromising on cleanliness.

The green quotient

Despite the conveniences washing machines offer, many of them also consume a substantial amount of electricity and water. By paying close attention to performance features, it’s possible to find washing machines that use less water and energy. For example, there are machines which can adjust the levels of water used based on the size of the load. The reduced water usage, in turn, helps reduce the usage of electricity. Further, machines that promise a silent, no-vibration wash don’t just reduce noise – they are also more efficient as they are designed to work with less friction, thus reducing the energy consumed.

Customisable washing modes

Crushed dresses, out-of-shape shirts and shrunken sweaters are stuff of laundry nightmares. Most of us would rather take out the time to hand wash our expensive items of clothing rather than trusting the washing machine. To get the dirt out of clothes, washing machines use speed to first agitate the clothes and spin the water out of them, a process that takes a toll on the fabric. Fortunately, advanced machines come equipped with washing modes that control speed and water temperature depending on the fabric. While jeans and towels can endure a high-speed tumble and spin action, delicate fabrics like silk need a gentler wash at low speeds. Some machines also have a monsoon mode. This is an India specific mode that gives clothes a hot rinse and spin to reduce drying time during monsoons. A super clean mode will use hot water to clean the clothes deeply.

Washing machines have come a long way, from a wooden drum powered by motor to high-tech machines that come equipped with automatic washing modes. Bosch washing machines include all the above-mentioned features and provide damage free laundry in an energy efficient way. With 32 different washing modes, Bosch washing machines can create custom wash cycles for different types of laundry, be it lightly soiled linens, or stained woollens. The ActiveWater feature in Bosch washing machines senses the laundry load and optimises the usage of water and electricity. Its EcoSilentDrive motor draws energy from a permanent magnet, thereby saving energy and giving a silent wash. The fear of expensive clothes being wringed to shapelessness in a washing machine is a common one. The video below explains how Bosch’s unique VarioDrumTM technology achieves damage free laundry.

Play

To start your search for the perfect washing machine, see here.

This article was produced by the Scroll marketing team on behalf of Bosch and not by the Scroll editorial team.