A Letter to the CM of West Bengal - In the Context of RG Kar Incident

To

Ms. Mamata Banerjee

Chief Minister, West Bengal

Nabanna, 14th Floor
325, Sarat Chatterjee Road

Mandirtala, Shibpur,

Howrah, West Bengal

PIN - 711102

Sub: Recent incident at RG Kar Medical and some concerns of the undersigned

Dear Madam,

We are a group of concerned citizens of Bengal, though at present some of us may be staying outside the state. We wanted to express our concerns and some possible steps that may be taken to address the issue of public healthcare constructively.

We want to state that none of us are directly or indirectly involved in the incident in any way, or also part of the government of West Bengal. However, because of our long professional backgrounds, aided by being part of many such peer groups (we come from institutions like IITs, IIMs, etc.) we have been exposed both as consumers and service delivery of similar public healthcare services across India, and we want to present the same here.

This communication should not be construed as an assessment or critique of the current state. The only intent is to contribute in any way to better the situation. Also, for that, all the undersigned will be glad to contribute in any way feasible and possible.

Notes:

Please note that some of these suggestions may have already been implemented, or are in the works. In that case, the undersigned has included them because the same can’t be found during our research.

The undersigned also believe that the healthcare service has significantly improved in West Bengal over the years, with some of us personally benefiting from the same. At the same time, a large number of citizens can’t benefit from the same – either because it is not available close to them, or they are too worried about approaching the health service centers (and being exploited), or simply not aware of what is there.

This is well evident in places like Bengaluru Chennai or Vellore, where any visit will show hundreds of visitors from Bengal in the reception lobbies. Such is the demand that now all the corporate hospitals are appointing Bengali staff not only as admission consultants but also as support staff in every function. In almost all cases, the patients work with very limited information and are goaded to a non-Bengal hospital by an interested intermediary at their place of residence, and a significant spend for the treatment which often puts the family in perpetual penury.

This not only is a revenue loss for the state and a negative brand image, this also sub-optimal healthcare as in most cases the family is in no position to deliver continued healthcare because of distance, resulting in continued degradation of the patient.

1.       The entire list of healthcare facilities needs to be published in both digital and physical form for people to know what is available to them. This will include (but not limited to)

-          Name, address, and facilities of all the PHC, CHC, Tertiary, District, and Super Speciality hospitals.

-          The process for availing treatment in each of the healthcare facilities should also be defined for each of the subcategories separately. For example, if one is to visit a PHC what are the documents needed (Swasthya Sathi card), what cost involved, registration, etc. if needed, possible waiting, etc. Also, it should mention what can be done in case the facilities as stated are either not available or not provided.

-          All the details as applicable to the particular hospitals/ healthcare facilities/ testing labs etc. should be printed and published for each of these institutions.

-          All communication needs to be in Bengali (essential), English, and possibly Hindi.

2.       The hospitals have to be sanitized for the people who are entering, as the majority of the people fear that they will either be approached by agents, or they need to connect with agents to get even basic treatments. We suggest the following (apart from point no 1)

-          The entire campus has to be lighted well. LED and Solar may explored from a cost perspective. If there are areas that remain dark, there should be a way to close them out from the public, with strict visible punishments in case of violations.

-          CCTVs should be used rather than security. They are far superior to physical guards in many respects and also cost-competitive in the long run.

-          A Building Monitoring Room (BMS) is to be set up to constantly monitor the CCTV feed. This will create adequate deterrence to crime. Also, based on the feed people may be identified and questioned for their presence on the campus.

-          Appropriate multi-language signages are to be provided at identified locations to reduce the need to seek help and increase the chances of potential manipulations.

3.       Wearing the uniform and the badge is to be made mandatory. Also, the security members should have the authority to check any identity on demand, including that of the Principal. The healthcare centers are for caring for people, not for displaying ego.

Entry to any department of a public hospital must be strictly controlled on a 'need to be present' basis by security staff deployed.

For any incidents of crime in the facilities involving doctors, nurses, and other healthcare workers, prompt action like filing of an FIR by the head of the Institution, (like the Principal or Superintendent) is a must. The institution head, in collaboration with the Police, should be jointly responsible for securing the Crime Scene/ Place of occurrence at the earliest, to avoid any allegations of tampering of evidence.

Forensic investigation should be done by experts from outside the Institution.

4.       The patient's right to be actively displayed across the healthcare centers, in multiple languages. Also, there should be inquiries at multiple locations for people to discuss issues, including understanding their rights. CCTVs should be used to monitor the inquiries (and registration/billing counters) for both video and audio, as these are places where the first impressions are made, or the first misguidance starts.

The patients should also be made aware that at any point in time, they can highlight their issues, including seeking to know the identity of anyone who is or claiming to be a service provider on behalf of the facility.

Adequate channels, including desks at the hospitals (which should be monitored with audio-enabled CCTV) and online need to be provided. This will include the right to provide anonymous feedback/complaints, given the fear of retribution especially among the underserved.

Complaints about corruption in admin and academic affairs need to be taken seriously and disposed of in a timely and transparent manner by the Vigilance department or other competent authority.

5.       The deployment of temporary staff members recruited by the government (like CIVIC Volunteers) should be completely avoided in healthcare facilities.

The low salary, high political connections, and vulnerability of the patients and their families the hospital is the most perfect location for abuse and has the highest fallout of negative fallouts.

6.       Technology should be leveraged as much as possible as people trust technology, and also almost all have a phone today (often a smartphone).

Options like Jugalbandi (

https://www.jugalbandi.ai/

) in multiple languages are a reality today and will be done. There is an ecosystem in Bengaluru and other cities that will be happy to help for free and can be explored if there is government advocacy for the same.

Also, all healthcare facilities are to be geotagged, and with basic descriptions of the facilities available. This will help the patients to do a quick search using Google Maps with text like “PHC near me”.

Also, the phones at the facilities need to work. The connections are cheap today, what we need is a culture of taking the calls or calling back in case it is missed.

7.       A large number of patients from Bengal visit hospitals outside, as there is a widespread network of vested interests who create a doomsday scenario, and often say the treatment is only available if a specific doctor in a specific hospital in a specific city can provide the redressal. These networks need to be discouraged.

Also, Panchayat-level campaigns are needed to update about the facilities available near home, and also at Taluka, Block, District, and State levels.

The citizens should also be aware of the ability of the elected representatives to help in the treatment, including recommendations for the same.

8.       A fail-safe method needs to be adopted to ensure that no staff members (and not only the doctors) should do more than one shift continuously. Apart from being dangerous from the healthcare perspective, we know that sleep deprivation is the single most important reason for any conflagration where the instigations are low by any benchmarks.

Technology can easily be used through the use of RFID or other Near Field Communication Devices to check the duty burdens at the individual levels, analyze the same, and resolve them with urgency.

9.       While every entity responsible for providing healthcare services is important, it is a reality that at the pinnacle of the public healthcare system in Bengal a handful of providers like NRS, RGKar, MCK, and SSKM are the pinnacle of the system. They are trusted by the people and often seen as the best treatment that is available to a common person.
Each of these identified hospitals (maybe a total of 20 across the state) may be taken up as a special project, a team may be formed, with the goal of tangible, measurable improvements in a given period. If this achieves even a 10% upward movement, it will be nothing less than a revolution.

10.   A partnership with the civic society can help in bringing best practices as well as selfless volunteering. Kolkata is often seen as the city of many old people, but they also provide a knowledge and skill pool that may be tapped into for various initiatives if the right environment is created. The same will be true of other regions of the state.

Also, members of the civic society around each of the institutions can play a vital role, as it is in everyone’s interest to have a good healthcare provider nearby. Also, efforts should be made to involve some of the students and Junior Doctors in some aspects of the administration, like hostels or hospital facilities. Done right it can give rich dividends.

An additional initiative may also be using the Bengali diaspora in the country and abroad to communicate about the good things that are happening in the state in healthcare (and other fields too). We can say from our personal experiences that the news that travels from Bengal to places outside is disproportionately negative than positive, and it gets magnified by Social Media. A small group of committed diaspora can play a vital role in reversing the same.

These are some of the thoughts of the undersigned. As stated before, these may already be done, or planned to be done. The government remains the best judge on what can or should be done. However if there is any value seen in this communication, and if so, if the undersigned may contribute in any way, please let us know at the below-mentioned contact details.

Thanks in advance and kind regards.

Signatories:

1.       Dipankar Khasnabish, (M) +91 81056 69696  Email: dkhasnabish@gmail.com

2.       Biplab Dutta

3.       Tapas Ray

4.       Umesh Kumar Dubey Email: dubey.umesh@gmail.com