The summary of different kinds of interviews conducted during the research phase of the project.
Research interviews of medical practitioners who have worked across multiple cultures in different demographics. Most of them have an Indian origin or education and were able to compare the difference in practices across boundaries at both the micro and macro levels of the industry.
Micro Level Health Dr. Anuj Singh:
- The demographics of the patients who come to Patna for treatment: People come from all over Bihar & Jharkhand.
- The financial challenges that are faced by hospitals due to the mindset of people and their expectations. People hope to get discounts based on their affordability criteria and personal connections.
- The working of the pharmacy inside the hospital because of medicine affordability is a challenge. People ask for discounts and it is hard to turn down people in need; both ethically and according tot he law.
- The families accompanying the patients need space. There are restrictions inside and outside the hospital for accommodation.
- Way finding signages are accompanied by supervisors who guide the patients through he process of the hospital
- Manpower issues of staff post hospital treatment. Most patients cant afford home nursing and request help after their time at the hospital
- Shifting a patient from the bed to the wheel chair and taking them to the bathroom. At least four people are required. For the task.
- Ambulances are generally on time in the city, but within the villages the service does not exist. Most ambulances which make it there may not be equipped with proper equipment.
- Electricity cuts are frequent but we have power backup in the hospital.
"Try and understand the psychology of the patients that come here. How are they different from a metro city?"
"There is money cut everywhere, and it is hard to incorporate that without insurance"
"The families come and stay overnight in the hospital. We have started opening up the waiting room at night for them"
Nurse Practitioner Divya Chitkara:
- Wheelchair and stretchers are outdated. The wheels don’t work and the the lock systems are all broken. It gets very hard to operate them. Legally, there should be two staff members and a staff with the patient at all times when on a stretcher. When optional, people prefer to walk. Generally when patients are transferred to the OT, there is no pillow to support the head and glucose bottles are kept next to the body of the patient. Ivy stands may be absent from some stretchers.
- Lifts have limited space. Staff and patients cannot get in together, so people generally give way to the stretcher and wait themselves.
- Sometimes, nurses are not well educated. Head nurses have to constantly instruct them on their tasks. So a lot of the tasks are patient dependent and cannot happen without their incorporation.
- Infection control is a big system in a hospital. Ideally, open hair is a problem. Hospital waste management system plays a huge criteria in infection control.
- Power generators are used for immediate energy. ICU’s and OT’s keep running. Infusion pumps need to be charged and are always being charged during electricity timings. Timing of requirement is key to requirement of equipment. There are approximately 40 infusion pumps at one place.
- Nurse calling stations are not present in general wards. Patients or families speak out loud to summon help.
"Infection control is a big system in a hospital. Ideally, open hair is a problem. Hospital waste management system plays a huge criteria in infection control."
"Wheelchair and stretchers are outdated. The wheels don’t work and the the lock systems are all broken."
Macro Level Health Dr. Sanjay Agarwal:
Departments we target while strategizing:
Curative health services: opd , admission
Primary care, secondary care: opd journey
Pre service activities: access issues: tools & mechanisms
Indoor hospital based journey: admission plus technologies
Clinical specialties: medical facilities
Service divisions in a hospital:
PHC Medical Practitioner Dr. Saaransh Desai:
- A PHC is essentially just one room. One part of it is the doctors desk, and the other part has a small pharmacy. People stand and wait in the remaining part of the room, sometimes even outside.
- You need to understand how the financial structure works. That is the primary reason why there has been limited development. For anything that costs more money, patients are recommended to secondary or tertiary care units.
- The mindset of the people is very different. Almost 50% of the times, people do not follow the doctors recommendations. They feel their home remedies are better.
- There is a lack of expectations compared to the USA. Even in the remotest setup int he USA, people expect certain things from a hospital. In India, the patients survival is his problem. This creates a sense of own responsibility and fear amongst the patient.
- In a government setup, the medical centers are either too big or too small. Either people get lost and don't know where to go, or the setup lacks essential facilities.
- Doctors don't want to work there. The work is not challenging and there is much more to a doctors career than looking at primary healthcare with the most basic tools.
"The mindset of the people is very different. Almost 50% of the times, people do not follow the doctors recommendations. They feel their home remedies are better."
"There is a lack of expectations compared to the USA. Even in the remotest setup int he USA, people expect certain things from a hospital. In rural India, the patients survival is not taken as a responsibility. "
Conclusion and future interviews
Many interviews provided valuable insights into the working of the healthcare setup. Many conversations began by providing a landscape of the environment the concerned people worked amongst. It then slowly penetrated into specific questions and an attempt to understand the psychology of the people involved in any practice.
A lot of people felt it was hard to pinpoint issues since many issues have been improvised within the system and the practitioners are now used to them. It is thus essential to do constructive primary research and observe the claims which have been made by different people. It is essential to note that certain 'problems' of a particular area may not be seen as a 'problem' in another region. This change in mentality and psychology is essential to understand which systems have been successful and which systems have failed.
Further to the conversations I have had over the phone and video conferencing in the last two months, I hope to physically go to centers and converse with medical practitioners to understand these problems further. During the field research in January, it will be important to both observe and question some of these points of concern.