Tuesday, March 24, 2009

The plight of Hospitals in Chennai

Aahaa Kaapi klub today was quite a revelation. Today's topic was triggered by a TOI article on how the ICU patients in KMC hospital had to use the stairs, Cardiac patients and burn victims inclusive, as the lift has not been functioning for 4 days.
Based on that I asked the people in the city of Chennai to call in with what they had faced. And I had absolutely no idea this was happening. Whenever the important ministers land up all the general hositals are cleaned and then they go back to the same crappy state.
Visitors of the patients dump garbage within the wards which leads to the breeding of mosquitoes. What would they do they ask, the wards are already full of crap.
Post delivery, a mother and her new born were brought to a ward, where nightfall brings a horde of dogs inside. The mother had to hold her child on her lap through the night for fear that the dogs would take away her child.
People who come in for fractures and related issues at the GH - the ward reportedly stinks beyond compare.
A man brought in his friends who had faced an accident at OMR to the GH. The ward boy demanded 300 bucks and because the man who had brought the victims had no cash on hand, he 'dumped' the patient, who had been bleeding all along at the back of the hospital somewhere and disappeared. By the time they figured out what happened, the victim had died. The ward boy is happily going about doing his job somewhere
Royapettah hospital - some of the famous specialists of Chennai who practise there apparently work out of "thatched roof" buildings as reported by a caller, and Royapettah housing some of the biggest politicians of Chennai is in this state.
Patients there, post operation have to wheeled across the main road, facing all the infection dust and traffic to go to the General ward.
Most of these general hospitals have issues with the Electricity board which means no electricity. Thats the case with the GH as well.
CGHS tells patients to get their medicines afterr 10 days.
Ward boys and other attendants bargain with the relatives of patients in lifts on how much they should be paid.
Hospitals like MIOT have more or less the same issues as far as these attendants are concerned. More than anything else, nurses and doctors apparently have mouths as foul as the GH itself.
I wonder what those people in GH are being paid for. As all the callers said, the employees are cocksure that nothing can happen to them since they are all government servants. How come the Union Minister has no clue about all this beats me. And more than anything else I wonder what salt the doctors working at the GH are made of.
Anyway, there was a lot more that was said by the callers today. Some of them have slipped my fingers right now. But what you have read is as said by the callers. I intend to post the inputs on the blog soon. Maybe a Podcast.

Just like there movements for cleaning religious areas, I wonder if there are movements that clean the hospitals.
Now that you have read all this, do you have a solution?

37 comments:

Sathiya said...

The only solution that I could think of is privatising the hospitals....rather than giving bribes and getting treated in such an unclean environment, they can pay a nominal fee and get a good(hopefully) treatment.

Otherwise there has to be security cameras everywhere. Each and every activity has to be recorded. Ofcourse there are ways to getaway with this but atleast the emergency situations can be handled immediately.

Narayanan Hariharan said...

What's this Aahaa Kaapi klub?? Never heard of it! Does it have a website or Google Groups or something of that sort?

Chinmayi Sripada said...

its my live radio show on Aahaa Fm 91.9
Strange how it seems new to you.. I have blogged it before as well..
It used to have web feeds but is not longer live.

Narayanan Venkitu said...

No wonder, the CM and the likes get treated at Ramachandra and other Private hospital.

H Y P O C R I T E S !!

nsrajan said...

Hi,

We all know it. So long as we dont go to GH, we dont feel it at heart. Of course when we read or watch news track on hospitals plight or lack of facilities of plight of poor patients, we feel bad and want to do something.


There are a few things that we can attempt
a) Move court and get some directions
b) Liasing with politicians will not be of much help. because they are the root cause of it and they know what is happening but dont want to do anything.

Vote out these fellows. Politicians and Dravidian parties in TN have been given enough time. They dont seem to improve basic things for lowest layer of people. We have to vote out these people.

Y'day or day before was a news item saying TN Govt gave cycle and first aid kit to Tsunami affected victims. These affected people where angry at the Govt inept working in not understanding what is required for the people. They felt fibre-glass boats or soft loans would help their livelihood rather on cycles on beaches. Also they wondered how to use the first aid kit and its relevance. Seems TN Govt had spent 100+ crores for it.

All our Tax going a waste in the form of color tv sets, cycles to needless, relaying tar roads every month etc

We need a strong clean leader who can bring about the changes across the vertical benefiting all sections of the society.

Root for it from now on. Spread the message. change is inevitable.

Sundar

Jayamurugan said...

Hi Chinmayi,
Privatising the hospitals may help out, but I am not sure of the nominal charges there, because most of the private companies want to make profit and very rarely we could see private companies working as service-minded.
Instead, all the government hospitals under a state can be clubbed under an independent organisation which would be under President control[I mean other than those government departments which hinders the functions of hospitals].
There should also be a hotline number which will take immediate actions incase of any complaints received.

I thought of raising one more concern here. In MTC buses[Yellow and green board buses], tickets are priced like 3.5, 4.5 and so on. Most of the conductors are not giving the 50 paise change when we give money. I could understand their problem but just imagine if a conductor who does not give change for 10 people[minimum] on a one way journey then he will earn Rs.5 and considering that the bus will ply for a minimum of 10 times[full trip] a day, he would earn Rs.100. I had read in a recent article in TOI that 50 paise should be considered as told by RBI. Because even some of the shopkeepers are not accepting 50 paise telling that it is 'selladha kasu'. I think better solution for this is to round off the ticket price. I am sending a mail to mtc_chennai@vsnl.net. Lets see if I get any response.

Bala said...

this is one such important issue that needs to be addressed with the highest priority... because it deals with the lives of the people... that too needy people who are not rich enough to reach the rpivate hospitals...

compliants has to be registered on the employees who demand bribes from the patients... these compliants needs to be registered not only with the concerned people in the hospital, but also with other government departments such as vigilance... Until some of the employees are punished, this is not going to stop..

awareness has to be spreaded among the patients and the visitors about the necessity of hygiene and cleanliness...

can form groups of students, IT professionals, doctors and other NGOs to create a drive to clean the hospital premises as a social service... if people like you, who have voice among public & media initiate such movement, it reaches to a very large masses...

From my side, I am ready to join in such drives, if one was started...

Anonymous said...

Hi Chinmayi,
I have been a silent reader of all your blogs. But todays blog had made me to write. first thanks to you for bringing the issues in public space. When one thinks of all the uncanny behavour of fellow indians, what first comes to mind is "will there be a change. No hope!!". But i am super optimistic seeing people like you. When my friends are flying abroad for a better life( atleast there they dont have such silly irresponsible acts that eats our life), i chose otherwise.Sometimes, having experienced irritating things around even I feel like fleeing away. But as optimistic indian, i would want to teach all young students, not to behave badly (showing examples), to be responsible, to nurture civic sense. Atleast the next to next generation doesnt see such things... You can say morals in your show.. if it could bring a change of thought in one person's mind, you can boast of having done something useful in your lifespan to our country.

! ky said...

Hey Chinmayi,
There are many things that happens in these hospitals, wat i felt weird is some sell out the used cotton that is used to wipe off all the wounds n stuff. They sell this used cotton to those who make cheap cotton buds which is sold in traffic signals n even in pondy bazar near naidu hall. The person who buy this used cotton remove the stained part wash the cotton with calcium which makes it pure white n then use it to make buds out of it. So should use only buds of johnson & johnson.

As bala said v should form a group for social service with those who r interested, this will make a difference n as u hav the power voice which reaches many can pass on this information.

sreekrishnanv said...

Strict rules on Health Care and Enforcement department. I think if MIOT and GH are of the same level, then there is wrong with the way you deal with health care.

We need strict regulations and strong laws to penalize whoever is going down on set and accepted benchmarks of service.

Is the "health minister" listening to your show?

vIcKy said...

Any clue on when aahaafm.com is going to up again??

பிரியமுடன்... said...

Patients......Should have
Patience!
//Post delivery, a mother and her new born were brought to a ward, where nightfall brings a horde of dogs inside. The mother had to hold her child on her lap through the night for fear that the dogs would take away her child.//

OMG! its a riduculous situation!
What is the hell....health ministers have been doing there?

Mridhool said...

Video Video Video! Everything should be caught on video. Even if it slams our privacy. A panel should be recruited -private group- and they should view these video. (now, I can imagine how tedious this act would be.) And this group should identify any such act (from the videos) and bring those video shots in public.

What needs to be done to the guys caught on cam, the public will decide. It is not that we are taking law in our hands. It is that these kind of people DESERVE it. If 5 people are caught, atleast 5 other people will try to be kind.

And, such behavious of ward boys and nurses would very well be known to the hospital management. So the wholo structure is a mess.

// I have been a silent memeber of your blog so long, chinmayi. I was listening to this topic this morning. I was SHOCKED beyond explanation. Infact whole thro today I have been thinking about how people can ever be so unkind to fellow humans. I wonder whats happening in the vetinary hospitals. I dread to think about that.//

Vijay said...

There is something called MTBF(mean time between failure)... So people can ensure, after measuring the state change of hospital service, just after the Minister of higher official visits... We can ensure/force those higher officials to visit the facilites (it is their job) as inspection.. nothing like it to have a great sense of success.

See what Lalu has done to Railways, just empowering people to do their job, well.

Heard that in China and Russia, ministers visit major hospitals once in 45 days! No wonder they are good in healthcare!

Anonymous said...

Chinmayi

I read your blog every day without fail and enjoy the articles a lot. The plight of hospitals cannot be changed in India as long as become privatized. But if they are privatized people like "Health minister" loses his control over it which he would not like. Well maybe next time all politicians should be taken to GH in case of emergency and be treated the same as general public only then they will understand the plight of a commoner.
Thank you.

Anonymous said...

Hi,
Very good topics.I couldn't do more than praying for those people who are suffering. I could very well understand the pain since I experienced myself. once I waited for 2 hr for doctor to come from lunch and give treatment for my broken wrist.

Last couple of year I keep hearing health minister talking only about ban smoking (I understand importance of the issue) it becoming too much and targeting all top actors which is really ........ :-(

I am currently outside india and I see govt hospital works better than private hospital here in this country. Wish the same to happen in our country atleast in next generation.

Barath.M said...

oh..i never knew such things happen in GH. This is really a pathetic state.. as far as i know, the only solution is to take the case directly to the union health minister....

Anonymous said...

Maybe we should form a volunteer group and the group members should take turns and be in the hospital and ensure that the ward boys/nurse/etc are doing their duty properly. The group should have tie-ups with some top lawyers/consumer court/RTI forum etc.so that we have a backing.
From my experience, it is only money/power that scares people.

Savitha said...

Chinmayi,it's not just the plight of govt hospitals,govt schools are also in bad shape....If we could lsit out,(As you had mentioned in your earlier blogs), there is so much of cleansing alone needed in TN,besides the 100 other issues. Well, coming to the hospitals, privatisation has,forsure,widenend the gap and has blinded our eyes for the plight of govt hospitals. Why don't we, as citizens of India, claim responsibilty for this ignorance(not only blaming the officials), and rally a movement??There are 100's of people who are interested in doing something....For eg., an art competition on such topics can be conducted in schools, colleges and a few among them can be picked up as posters and made public....The power of youth(including me and you,eh :)) can be channelised into such activities(I,having been a lecturer have experienced that given a spark, they'll do it really BIG, and inspiring.....).I think we can not waste time waiting for our petitions to be answered, our PIL to be brought up etc. If there are a volunterring few(just a few),we can mobilize, basically, through colleges and I am damn sure,we can arrange for funds,for a project like this.....

karthik said...

Yes. We do clean up the hospital premises.

Kilpauk Hospital Cleaning

Anonymous said...

Good to see a famous celebrity like you bringing awareness of these issues. We, a big bunch of youth are already on our way working on some of the problems, here are some links which might interest you.

http://yespluschennai.blogspot.com/

http://bawandinesh.name/reservations/

http://bawandinesh.name/inconvenient-questions-i/

Sundari said...

Be it a Govt hospital or a Pvt hospital, we see a lot of negligence everywhere.Getting Proper medical facility is also a Basic right of every citizen.There is no point in just seeing these things happen around.People should be ready to go to court and file a case against these things.But how many people are ready to go to consumer court ? "No Time", "Busy","Nothing is going to change in just me doing this" these are the thoughts of most people.But someone has to step up make a start.Couple of issues raised high or brought to the notice of media would definetly gain importance and create an awarness.
People should also be taught how to log a case in consumer court, or for what all issues a person can go to consumer court.I beleive many are not aware of such things yet.

The below site might be useful in giving those information...I hope it helps someone...

http://www.icrpc.org/index.htm (International Consumer Rights Protection Council (ICRPC))

http://www.icrpc.org/icrpc.org.products.htm

Lotus said...

Privatizing hospital is not a good move, take US for a living example, they are a failed state in terms of giving medical help to a common man, without insurance you cannot even dream of medical treatment.
I am proud that Indian system of functioning is far better than any other country in terms of serving people and coping with recession. This Indian system will not fail unless we bring a change which will collapse. I agree the Government officials are corrupt and are very slow, but this is not stopping the progress or the work, something is being done.
We need to bring the awareness to the Government servants and the Public. Make the Govt. servants feel it is the service they are doing. We all should learn to respect them, recognize their work instead of criticizing them.
Let me remind you all no other country gives free treatment to the poor and needy except for India. There is a new trend in Govt. departments, profit and non profit. Health ministry comes under nonprofit dept. So, the money allocated to this is less, this is the starting point of a major disaster. This dept was formed to serve the people not to make profit. I hear many doctors spend less time in Govt. hospital and redirect their patients to private clinic. This is one of the reasons why you don’t get good environment in Govt. hospitals.
Please don’t make this system fail. Find the root cause, this actually starts from the doctor, not the worker in the hospital. I repeat, Give the due respect and reorganization to the ward boy, they will make things better. Doctors should be more responsible. Bring the thought in them this is my hospital.
The saying is dying “Work is Worship”

Servo R.S.Vasan said...

Dear Chimayee,

Nice to see your Blog. Superb English. Good this is Servo Srinivasan.Hope u remember me.Ref your Aaha coffee club morning show. I couldn't get line on 24th incidentally which was my B'day.Today on 25th I have just expressed my concern for your safety and my views on suggestions for Chennailities for voters. But unfortunately the very next caller has misinterrupted my views and totally changed the meanings of my expression on your safety. You know that I have added my company brand name and occupying a very good position in a Govt oil company and how can I even think of threatening etc. If you read this post tonight, please do correct the viewers to patiently listen to the callers before accusing others. Regarding Hospitals sure all fire accidents cases mercilessly killed during 2am to 4 am by Hospital workers by injecting in patients legs mainly to avoid cleaning and dressing them. My MIL faced similar death at Pondy on stove fire accident case. My aunt died due to wrong administration of medicines within 10 minutes instead 24hours to be injected through veins and she slipped into COMA and died in a private hospital at Chennai .These instances could have been expressed had I got the call. All the best for your career. Superb abilities u have oncompering, RJ and singing so on. Great dear. Lord Vaduvur Rama shall shower all His Blessings to you for a healthy and wealthy life.
With Cheers and Lov
Servo Srinivasan

Anonymous said...

//More than anything else, nurses and doctors apparently have mouths as foul as the GH itself.//

http://rural-doctors.blogspot.com/2007/01/public-complaint.html

Anonymous said...

//I wonder what those people in GH are being paid for.//

For working 48 hours.

Unfortunately the influential 50 percent work only 20 hours and the other 50 work for 80 hours

Anonymous said...

//As all the callers said, the employees are cocksure that nothing can happen to them since they are all government servants.//

True
They can even abuse a doctor and get away

http://www.hindu.com/2007/01/01/stories/2007010107790300.htm

Anonymous said...

//And more than anything else I wonder what salt the doctors working at the GH are made of.//

http://rural-doctors.blogspot.com/2007/09/block-medical-officers-letter.html

Anonymous said...

// I hear many doctors spend less time in Govt. hospital and redirect their patients to private clinic. //

Do you know the duty timings of a doctor who spend "less time" than what is stipulated

http://ruraldoctors.blogspot.com/2009/03/blog-post.html

Anonymous said...

dear chinmayi ,
I am one of those people who constantly draw inspiration to rise to greater heights, from your blog.

I was a medical student who interned at the GGH , Chennai.
The list of things the place needs is endless, can be attributed to lack of funds , mismanagement , theft etc.
i am not going to talk about that.
I am here to tell yourandom incidents/ sightings that apalled me :

The Assistant professor in my ward , casually asked us to indent expensive drugs under patients ( its for free)and made off with them to use for his private clinic.

A watchman in the septic ward charges RS. 10 to let visitors/ attenders in. Ive seen this exchange several times and chided him.

In this septic ward, the ward assistant (deputy to nurse ) "offers " to do the dressings for patients. Since it takes a long time for us Interns to finish All the patients, And we do the septic ward last , some patients unknowingly agree to take up the "offer " . After the quackish dressing , they are charged rs 50 to rs 100

In septic ward ,to shift a patient from the OT post op , anywhere from rs 100 upwards.

To wheel a patient for investigations ( ex: to take him from ward to x ray room , Around RS 50). When i was new i used to sit and wonder why the hell an urgent investigation was not done. Ans : patient didnt pay the ward boy.

While i found that one doctor corrupt , i must say the others who i worked under were exceptionally good ,genuine and caring.
The nurses are like sloths / slugs, they hardly move, make a lot of noise , weigh above 65 kg,and believe their sole job in life is to sit and draw lines on registers. and are somewhat benign in compared to the lower rung of uneducated employees.

The ward boys are incorrigible , hateful , lecherous bastards.
As someone on the bottom most of the hierarchy of doctors , there was nothing much i could do besides listen to patients grievances , console them , and TRY to check these lechers.
but theyve done it for forty fifty years . one little student , posted in their ward for a couple of weeks could not intimidate them , try as much as she could.

Im not defending myself and saying i did everything in my capacity , but i tried .

And yes , ministers generally admit their aged parents ( reason :cheaper , and they're going to die anyway + public admiration for using GH ). ITs hell when they come , ppl stand in attention or bend double in fear / respect. I tried to resist that and go about my daily work.im proud that i didnt stoop to say good morning to some godawful minister.

And in the maternity hospital, if the mother gives birth to a girl , they 'Gift' Rs. 300 to the Ayah. Boys bring Rs.500. Saddest part : the ayah takes them aside and says " ulla doctor amma/ ayya vangi vara sonnanga". This i came to know only after i finished my posting in maternity !!

Oh and worst of all they charge a couple of thousands to hand over a body from the morgue. or so i hear.

Im sorry/ ashamed to say i couldnt do much more than what i did as an intern.
But it has been cathartic to write about it here . Thank you.

Anonymous said...

//If you along with the other doctors could not change the scenario in GH please do not post excuses here.//

The information posted are not excuses but just additional details

If you do not want to know the root of the problem, but just want to scold others and vent your frustation, you have indeed succeeded.

Have a nice day.

AshWin said...

It is not the infrastructure,but it is the team which manages this crap , which needs to be punished .

NGO's and some private self help groups are doing their bit ..

but, Dog knows where its tail is ,

These ward boys and their peers are all greedy for money, nor they do posses the education to understand what we say ..

I too did see "Anonymous " weblinks .. they r real good,

Please let me know their blog or contact , if they mailed you , I will join their group to do my bit ..

Padmini G said...

I don't think privatising the hospitals is the solution for this problem. The tendency to ask for bribe is coming from greed, so that same person will still ask for bribe in private hospitals. Doesn't all public and private hospitals falls under the wing of the health ministry? It is the health ministry that should enforce tough measures and regulations in all hospitals to ensure that the health service is in utmost efficient and reliable state. This includes ensuring that there is enough staff manpower, health equipments & medicine, reliable power supply, proper remuneration package for staff (so that there wont be any reason to ask for bribe). The hospital director/ head should also ensure that all regulations are strictly followed and no hanky panky things are going on in the hospital. This is the basic thing - everyone will follow the leader.

Anonymous said...

Well if you think i have posted excuses , i kindly request you to remove my comment that you have posted on your blog.

BlaaZe said...

hey guess i missed the show..damn.. here's what i witnessed when my mother was not too well...

MONDAY, DECEMBER 15, 2008
My mother's ordeal... 'open' letter to hospital


Rajesh Raman
Son Of Mrs. Sathyabhama Raman
Abhiramapuram
Chennai – 600 018
Date: 15th December, 2008

To
The Management,
Chennai Meenakshi Multispeciality Hospital Ltd.
148, Luz Church Road,
Mylapore, Chennai 600 004


Respected Sir,

It is with utmost disappointment that I am compelled to write this to bring to your notice the complete inadequacy and disrespect shown to my mother and fellow patients at your hospital.

My mother, Mrs. Sathyabhama Raman was admitted to the hospital on Friday, December 12th 2008. Having been under the care of Dr. GS Kailash, she is being discharged today, thankfully. Please note the following and do ensure the services are improved so as to help other unfortunate patients who may have to suffer the added pain of your services alongwith the illness already diagnosed. A copy of this letter is being given to all concerned departments.

Saturday December 13th 2008 - Room 211

9.27 pm – 10.00 pm

3 times was attended for medication / reports / drips
Nurse left patient on all three occasions half way…

(hospital excuse) – shortage of sisters

9.00 pm – previous 48 hours (since admission)

Patient has acute bronchitis alongwith other illness, and had been administered nebulisation – ON A BROKEN MACHINE !
Complaint in the form of a doubt was raised by the patient’s daughter-in-law, Nandini Raman, on first nebulisation, as it seemed to not work.(i.e. no trace of smoke from machine mask during nebulisation). No positive response from nurse who was attending and mentioned it is ..as is.
Second day of nebulisation, I, Rajesh Raman, was present in the evening, and being a severe asthmatic patient myself, knew the nuisances of the nebuliser, and this time when complaint was raised by myself, to the sister on duty, she AGREED that the unit being used since her admission to the hospital, was and still is…BROKEN.

(hospital excuse) – as a patient, you should have complained earlier, says the nurse!

Emergency Bell kept at bedside – response time - 7 minutes - after three rings and patient walking to desk to ask for attendance !

(hospital excuse) – there was nobody at the desk to attend to bell call.

10.12 pm

3 injections through intra-veinous (IV) was administered to patient in 21 seconds. Am curious as to whether this is common practice as my mother was in tremendous pain.

(hospital excuse) – this is the way it is done.

07.15 am Monday, December 15, 2008

After being in room 211 since Saturday, 13th December, the bedsheets of the patient have been changed only now, and that too after polite requests to do so by myself. 3 days later? A bedsheet change?

(hospital excuse-overheard) – lack of sheets

09.15 am

Dustbin changed and replaced WITHOUT removal of the bin liner inside, with cotton swabs and tea stains etc still in the new change. Complained to head nurse about some basic sense of responsibility required and prompt replacement was made.

09.30 am

Had to request for toilet to be cleaned … as it has not been cleaned since admission.

(hospital excuse) – not sure …


Am truly appalled by the further stress and pain an admission to your hospital may bring to fellow patients like my mother. Please do take action.
For God’s sake, if not for humanity.



Regards

Rajesh Raman
(15-12-08)

Chinmayi Sripada said...

To anonymous: I am not even sure how many anonymous commenters are here and who I am answering. So I guess I will wait until anonymous whoever can at least give a dummy name, its tiresome otherwise

viswa said...

Hi.. I'm a young doctor working at GH and am an avid listener of your show, which coincides with the time I'm driving to work, every morning.
This discussion about the state of our Government Hospitals is a very valid & interesting one. While on one hand I agree with the things that have been said especially with respect to cleanliness and the ward boys' asking for money, I would like to point out a few lacunae, which may be the reasons for the woes of GH.

1. The moment our bigwigs begin to come to GH, the things are bound to change. A few decades ago, when the top politicos fell ill, they were brought to GH and consequently the facilities improved and new equipments and a clean premises was maintained. My suggestion is that if our ministers/CM get admitted in GH (where, believe me, the quality of doctors and nurses are on par with outside) the whole place will automatically get a facelift in terms of cleanliness and equipment. Like how our PM goes to AIIMS, similarly our CM and others should admit themselves in GH. I am asking them to trust in the same system that caters to majority of their people.

2.The ward boys are employed through a contract basis. They have awful working hours of 12 hours a day and have to do work such as transport patients up the buildings when lifts aren't working, clean up the wards and toilets (which the patients & their relatives dirty indiscriminately) and sundry other things. Most of them are married and have families to look after. And for all this they are paid Rs.1500-2000 per month. The point I am making is that these people deserve a bit more for their hard work. I am sure that they would not ask for money from patients if they are better paid. Some black sheeps exist though and inspite of repeated warnings from doctors they continue harassing patients and have been thrown out on our insistence.

3. Our patients themselves are a difficult lot to deal with. Just come to the new tower blocks and observe the way they look after the public property. As usual, they spit everywhere, urinate in public (even when there are clean toilets maintained by the Corporation, within the compound), eat inside the wards and dirty everything around them. The latrine is a dustbin for them and very often in our daily rounds,we docs inspect the toilets and admonish patients who dirty them beyond scope of any clean-up. And it is left to the ward boys to clean up after the patients have dirtied the place. These people smoke in the ward and occasionally a few of them have misbehaved with the nursing staff too. Any number of requests/scoldings/threats don't seem to work for these rowdy elements amongst the patients (though most patients are very simple, trustworthy & lovable people).

4.There are few more ails affecting out system of healthcare. Though it must be said that TN healthcare is amongst the best managed in India. Obviously, there is scope for improvement, as we can see.. I hope you will take note and highlight issues from the other side of the fence as well.

5. I guess, we need accountability in our society. In every aspect. Surety of punishment and not its magnitude is the only deterrent to indiscipline.