Pandemic lessons: Ensure and improve access to healthcare services

Ninglun Hanghal
The non-availability of health- care facilities and services or medical professionals is considered a “normal” phenomenon in the tribal hill districts of Manipur. It is even accepted as part of the “fate” of being an inhabitant of rural and underdeveloped areas.
It will not be surprising to see dilapidated primary health centres in rural and semi-urban Manipur, if they exist at all in the first place. In some PHCs, there are a couple of State Health Department staffers available for a few hours at the most. But by and large, PHCs are either non-existent or non-functional and the presence of a doctor there is beyond the expectation of villagers. District hospitals in the tribal hills are in no better shape either.
Even if patients manage to reach the district hospitals, in most cases, they are advised to seek “Imphal doctors”—in other words, referred to hospitals in the State capital Imphal for better treatment and more advanced technology.
It is a normal and an obvious story in Manipur that, every patient who can afford to do so, from the rural areas, is taken to Imphal for medical treatment.
The situation has worsened in this pandemic. For instance, during the Nation-wide lockdown last year, a 20-year-old pregnant woman from Noney in west Manipur was taken to the nearest Senapati district hospital. Once there, she was referred to Imphal, about 70 kms away, only to be denied admission in all the five hospitals they went to in the State capital. Finally, along with her unborn child, the woman died at the entrance of a private hospital—12 hours after arriving in Imphal. The hospitals reportedly denied her admission on the grounds of Covid restrictions.
Unfortunately, this is not a one-off incident. As reported in the media and social platforms, patients from villages in the interior are brought to district hospitals on temporary handmade bamboo stretchers by villagers. It is a common practice across all the tribal districts of Manipur.
Last year, a patient was brought by villagers on foot in a bamboo stretcher, all the way from Henglep to Churachandpur district hospital, about 80 kms away. Besides the non-availability of public transport, roads are in such a bad condition that no vehicle can ply on them.
Pregnant women are frequently ferried in such a manner from villages to district hospitals. In August last year, the video of a woman in labour being rushed to a hospital in Manipur went viral on social media. A dozen-odd youngsters of Dunong village in Tamenglong district were seen carrying the heavily pregnant woman on a bamboo stretcher through a narrow, treacherous path to reach the nearest PHC at Tamei —located 54 kms away. Fortunately, the delivery was successful.
Many pregnant mothers, however, cannot make it. Recently, in mid-May this year, a young pregnant woman was brought from Sugnu to Churachandpur district hospital but could not survive. The distance is only 30 kms.
The primary reasons for such incidents is the unavailability of medical infrastructure and primary healthcare workers — forget doctors or specialists—in rural areas. Additionally, apart from the economic condition of rural inhabitants, the absence of public transport and pitiable road connectivity are major reasons for such a sorry state. Matters become even worse during the monsoon months from April to October.
Distance is one thing, but the pandemic has brought into sharp focus the predicament patients find themselves in. Such stories are indicative of the fact that healthcare services in the rural areas are literally absent or abysmal. Though one may not expect a doctor or nurse in every rural PHC, even district hospitals are without specialists or modern technical equipment.?
According to the Directorate of Health Services website, as per census 2011 maternal mortality rate stands at 64-80 per cent, institutional delivery is only at 68.3 per cent and mothers with  full antenatal care is only 46.7 per cent. Such figures are clear enough to say that even in the 21st century, hundreds of women continue to die while giving birth or during pregnancy. It also indicates that many pregnant women in Manipur do not go to a hospital for delivery nor have access to healthcare services.
Meanwhile, in early May this year, local media reported that seven doctors posted in Ukhrul district hospital were found absent from duty. The Chief Medical Officer was reported to have said that the hospital was in urgent need of specialists in anaesthesia, sinology, orthopaedics, blood banks and surgeries. The 50 bedded district hospital requires 30 doctors in various speciality departments. Due to such ill-equipped district hospitals and lack of adequate manpower, people are forced to travel to Imphal, the reports stated.
It may also be mentioned here that hundreds of doctors are produced every year at two of Imphal’s top medical colleges — the Regional Institute of Medical Sciences and Jawaharlal Nehru Institute of Medical Sciences. An equal number of nursing and paramedical students are also studying at various training institutes in the State.
There could be several reasons why doctors or medical professionals are hesitant or even unwilling to work in rural areas. Several more reasons why PHCs are non-functional or non-existent. And even more reasons why every patient, at the slightest hint of a minor complication, is referred to the State capital. But all of them pale in comparison to the loss of an unborn child or the death of a patient on a bamboo stretcher on the way to hospital.
Access to healthcare services is a human right. If at all there is a lesson to be learnt from this pandemic, it should be on ensure healthcare delivery and improving the healthcare system across the State, more so in scarcely accessible rural areas. And this will require holistic planning taking into account several other sectors, such as roads, public transports. But is anyone listening ?
Also published in The Statesman North-East Page