I was intrigued by the (attached infra) Preetu Nair article in the Times of India. I have to concede that TOI is not my favourite newspaper when it comes to health-related articles, and I am not aware if Ms Nair has any reasonable experience in health administration or even health care.
I do however have a few queries: [1] Having noted the total number of deliveries at the CHCs (Community Health Centres), did Ms Nair enquire into the number of pregnant CHC patients which eventually needed caesarean sections? [2] If the answer is YES, did this number warrant the placement of a qualified Obstetrician, anaesthetist and neonatal paediatrician on call on site 24 hours at each of the CHCs? [3] If not, why this article? [4] Will you be suggesting next that all CHCs have (say) MRI facilities? .... because they might not have any right now? [5] Aren't certain procedures which require multi-speciality care and care facilities, best handled centrally at better equipped tertiary centres rather than secondary centres - unless the load on the secondary centres (CHCs) justifies such an outlay of manpower and funds? I suggest that the amount of time it will take an obstetrician, Anaesthetist and neonatal paediatrician to travel from his/her home (say in Benaulim) to the nearest CHC (say in Chicalim) will be the same as it will take a patient (say in Chicalim) to travel to the Hospicio in Margao. [ as an example ]. Unless ...in this case scenario, Ms Nair is also suggesting that the CHCs have furnished accomodations and meal facilities for all the specialty doctors and nurses needed to be on call. BTW: It is naive to think that a centre for C-Sections does not need Newborn Intensive care centres. About two decades ago, I was in conversation with a non-clinical person heading GMC. Being a non-clinical person (I suppose) That person did not understand why a newborn centre needed nurses and doctors to run the centre. "The nurse from maternity can come and give the injections, No?" I wish journos like Ms Nair would use correct terminology when writing medical articles.....or at least run the article by someone in the field you might happen to know. Granting that all obstetricians are also trained in gynaecology, the physician who performs a c-section is an obstetrician, and not a gynaecologist. It is a question of which hat one wears. jc === http://timesofindia.indiatimes.com/Cities/Goa/Goa-CHCs-lack-basic-c-section-facilities/articleshow/4708605.cms Goa CHCs lack basic c-section facilities - Preetu Nair PANAJI: While the Goa government crows about it’s ‘top-notch’ healthcare facilities, a recent survey found that 80% of the community health centres (CHC), first referral units (FRU) in an emergency, are not equipped to conduct even a simple caesarean section. The survey found that only one CHC, of five in the state, has a qualified gyneacologist able to perform a caesarean. The survey was conducted in 2007-08 and health director Dr Rajnanda Dessai says there have been changes since then. “The situation has improved and we now have gyneacologists in most CHCs. A caesarean is, however, not done at CHCs due to certain inherent factors.” The ‘inherent factors’, include the lack of a blood storage facility and the non-availability of an anaesthetist. Sources also say there are times when doctors at CHCs don’t want to take the risk. The survey, conducted in 2007-08, found that though three CHCs had a functional operation theatre, only one, Ponda CHC, had a general surgeon and though they have been designated as FRUs, none had facilities to store blood. Dessai, however, assured that this would change. “We are working on improving the situation,” she said. There are, however, no caesareans performed at primary health centres (PHC) as these do not have a gyneacologist. Though normal births are possible at CHCs 24 hours a day, the average number of deliveries a month at all CHCs are 60 and at PHCs even less, at 30. Compared to this, Goa medical college and hospital on an average conducts 123 deliveries a month.
