FOR THE POOR, the meek, the humble and the underprivileged, the Goa Medical College is the God that failed. There have been, over the years, hundreds of horror stories of callousness, insensitivity and criminal negligence. The latest case in point is the story of the young man whose hand had to be amputated because of the criminal negligence of the killers masquerading as healers. RAJAN NARAYAN traces the decline and fall of the Goa Medical College.

IT IS EASIER FOR A WHOLE caravan of camels to pass through the eye-hole of a needle than for an ordinary, poor, underprivileged patient to get attention or effective treatment in the GMC. Which is ironical because the Goa Medical College (GMC) is the only public hospital in the State which has the entire range of diagnostic and other facilities.

I have personally not experienced any delay or rudeness or indifference on my several visits to the GMC. Presumably because I am a VIP and a journalist and I know a lot of doctors including successive deans in the GMC intimately. But recently, when I went for a CT scan at the premier hospital in the state, I was shocked. Because the air-conditioned room in which the brand new state-of-the-art CT scan equipment has been installed was full of flies and mosquitoes. The platform or bed on which patients are expected to lie down to have their CT scans was smeared with blood and God alone knows what other infections. When I asked the senior radiologist present why there were so many flies in the CT scan room, he merely shrugged and talked about infected patients bringing in the flies. Other doctors present in the chamber overlooking the CT machine in the monitoring room insisted that nothing could be done about the flies swarming the room in which the CT scan machine is installed.

Cover story....... (Goan Observer, July 3 - July 9 2004).

There were no flies or mosquitoes in the control room where the doctors sat and monitored the CT scan underway. You are expected to lie down totally still when the CT scan is being done. How do you accomplish this feat if flies are sitting on your exposed feet and even your nose? When I asked the senior doctor how this could happen, he told me quite casually that there is seldom a problem in getting funds in crores for buying expensive diagnostic equipment like CT scans. But of course even if the Head of Department concerned suggests installing a fly catcher costing Rs 5,000 odd the money is unlikely to be sanctioned. The senior doctor ought to know because he has been battling with the GMC for years to update equipment in the Operation Theatre.

Sometime ago the six-year-old son of a good friend began vomiting continuously. The parents rushed the child to the GMC. At the casualty ward, they referred the child to the paediatrics ward. The child by which time had developed a very high fever also. For four hours the child received no attention whatsoever. The disgusted parents brought the child back home in despair. I learnt about what happened only around 1 am in the morning as I had gone out that day for a party. The child was still burning with fever. And he had got totally dehydrated because of continuous vomiting.

I took the child back to the GMC. I was so angry that I told the then Dean, Dr BN Reddy that, I would burn down the GMC if anything happened to him. Because of my intervention the Head of the Paediatrics Department Dr Philomena D’ Souza was summoned. She came very reluctantly, obviously annoyed about being disturbed in the early hours of the morning. But once she came she examined the child meticulously and appropriate treatment was provided.

All the years I was in the Herald and even now not a day goes without my receiving a call from the relatives of some patients or the other. Including relatives of my former colleagues in the Herald. Inevitably it is the same sad story of callousness and criminal neglect. The patient had been admitted to the GMC in a critical condition. But nobody had come to see the patient except for the junior or senior residents on duty. Could I please call the Dean or the Medical Superintendent or some senior doctor so that the patient was attended to before it was too late?

It is obvious that nobody trusts the GMC. Particularly the poor and the underprivileged for whom it is meant. And I can understand why nobody trusts the GMC. I can understand why people are so afraid of the GMC. I can understand why people look upon the GMC as the very last resort. The problem is just not insensitivity and callousness. Ironically, unlike VIPs and politically connected patients, nothing is free any longer in the GMC. Just 48 hours before I went for my CT scan on Saturday my maid servant had taken her mother to the GMC for a CT scan. She was asked to buy the disposable syringes. She was asked to buy the expensive dyes that are injected into the body before a CT scan to get a contrast image. It did not stop there. She was asked to buy not one, but three vials of the dye. Though only one was used the other two were not returned. My maid servant who earns a grand income of Rs 2000-3000 a month working as a domestic in the houses of the bold and beautiful and the rich and the powerful in DonaPaula had to spend almost Rs 800 to get the CT scan done on her mother. If you are just an ordinary citizen, you are not likely to get an appointment for a CT scan for over a month. However urgent your need may be.

What is appalling is the insensitivity of doctors in the GMC towards patients. Dr. Shekhar Salkar who had been closely associated with the functioning of the GMC as the Chairman of the Visitor’s Committee, was deeply distressed about the manner in which the GMC treated a promising young footballer who had sustained an injury during a game. The young footballer was initially taken to the Apollo NUSI in Cuncolim. Since he was in a critical state, the Apollo NUSI did what all private nursing homes in Goa inevitably do. Packed him off to the GMC. The young man was taken in an ambulance to the GMC accompanied by a senior anaesthetist. His life, perhaps, would have been saved if he had been put on a ventilator immediately on arrival. But, no ventilators were free and the patient was allegedly left unattended to for almost an hour. Dr. Shekhar Salkar is agonised over the utter disregard for human life. If it had been their son or their daughter, would they have not made every effort to save the young man? In fact even if the patient is terminal, it is the obligation of the doctors to try their utmost to save them. Salkar told me that he could understand if senior doctors tend to be hardened as they have probably seen so many near tragedies. But surely younger people who joined the GMC, particularly the senior residents who form the cutting edge, should have some compassion, some humanity and the tiny spark of idealism that he and his generation had when they got into medicine.

Most departments in the GMC are very badly managed. In most departments in the GMC, particularly in the surgery department, you will be lucky if you find a senior doctor, who is called a consultant, when you need him. Because the doctor is probably away operating in a private hospital during working hours. In theory, senior doctors (consultants) are supposed to be on call 24 hours a day on specified days by rotation. Except that the doctors on call very seldom respond to calls. Because they are far too busy with their private practise and could not be bothered with some poor patient needing their urgent attention.
Over the last decade successive health ministers and even successive chief ministers have threatened to crack down on GMC doctors who engage in private practise. More recently the Health Minister had announced that action had been initiated against Dr. Mahesh Sardessai, the Head of the Department of Radiology, who incidentally has a flourishing private clinic in Porvorim and an assistant lecturer in the notorious Orthopaedics Department. Apparently the police had maintained a vigil both at the private clinic and the hospital and had established beyond the shadow of any doubt that Dr. Mahesh Sardessai spent all or most of his time at his private clinic rather than the GMC.

It was announced that Dr Sardessai would be asked to return all the non-practicing allowance that is given to all GMC doctors to compensate them for refraining from private practice. It was announced that the Vigilance Department would be asked to take suitable action both against the Head of the Radiology Department and the assistant professor in the Orthopaedics Department. But of course nothing happened even to the two doctors who were made to be an example of. And not surprisingly no action was even contemplated against the HOD of orthopaedics who also has a flourishing private practise because he is very close to the Health Minister, Suresh Amonkar. Presumably the other consideration is that if the GMC really starts cracking down on private practice it would have no doctors left. In fact over the years some of the best doctors have left the GMC because of what they see as continuous harassment or threats of being suspended or dismissed for engaging in private practise.

In a rush of enthusiasm Dr Suresh Amonkar, the incumbent Health Minister, appointed two consultants to improve the functioning of the GMC. The former director of the KLES hospital in Belgaum Dr A K Singh was appointed on an enormous retainer to study various processes and procedures. He was paid Rs 50,000 a month to spend three to four days every month at the GMC. Most of the suggestions he made were impracticable to the extent of being absurd. In any case there was no will to implement it either at the political level or the bureaucratic level.

On the insistence or persuasion of Dr Shekhar Salkar, a cancer surgeon in Goa and anti tobacco activist, it was decided to set up a trauma ward. This was intended specially for the benefit of accident victims in keeping with the maxim that the first hour after an accidental injury was critical. Special ambulances were purchased which were supposed to have been equipped with life saving equipment. A special team of doctors were appointed and an emergency operation theatre was set up. The super duper consultant from Mumbai, Dr A N Nadkarni, was paid a monthly retainer fee of Rs 40000 plus with perquisites like free air travel from Mumbai to Goa and back, accommodation and car at his disposal. The trauma unit is virtually moribund. Perhaps the biggest drawback is that the trauma ward is not equipped with sufficient ventilators.

Though the consultants have disappeared one extra constitutional authority who was brought in, courtesy Dr Wilfred De Souza when he was chief minister, continues and flourishes in the GMC. We are referring to Dr Chico Vaz who was employed as a senior consultant at a munificent salary. No harm in that, as Dr Chico Vaz is considered a very senior and very distinguished neuro physician with years of experience in the most prestigious hospital in Mumbai. Except that Chico Vaz exercises power without responsibility. Though he functions as a senior consultant and examines patients and treats them for neurological disorders including epileptic fits he has no responsibility. Because he is a contract employee. And unlike other colleagues in the GMC, Chico Vaz is specially privileged because he is allowed to engage in private practise. And if Chico Vaz makes a mistake he cannot be held accountable because he does not sign the discharge papers nor does his name figure in the discharge paper as a consultant. Among his other dubious distinction is that he persuaded the government to buy expensive equipment for nerve conduction studies. The equipment is lying idle because the doctor in charge was harassed so much that he left. And now the technicians have also disappeared. Chico Vaz offcourse continues to flourish.
When I am critical of the GMC I write more in sorrow than in anger. I have always believed and continue to believe that the GMC is the best medical facility in Goa. It is the only hospital which is equipped to handle critical cases. A longstanding complaint of the GMC doctors is that private nursing homes make a mess and then refer the patient to the GMC only at the terminal stage. And I do believe that there is a large measure of truth in this allegation. With honourable exceptions private nursing homes in Goa are death traps. If they do not kill you they will pick your pocket and bleed you financially. But the problem with the GMC is that over the years it has degenerated from being a concerned sensitive organisation to just another government department. The doctors atleast the majority of them have absolutely no commitment to their job. They treat their patients as nuisances who should be got rid of as fast as possible. And the politicisation of the GMC has undermined and destroyed the morale and the commitment of even the few doctors who still take Oath of Hippocrates seriously.
The biggest bane of the GMC has been politics. Everyone is engaged in playing politics from junior residents to even ambulance drivers. I recall a time when a driver from St Cruz recruited at the instance of Mummy Dearest even sought to threaten the then Dean Dr BN Reddy. Everybody knows somebody in Goa. So the doctors are under constant pressure. To give one instance all the doctors were required to dance attendance because last Friday the son of one of the sarpanchas owing allegiance to Luizinho Faleiro met with an accident. And Luizinho Faleiro marched in to the casualty with 50 people. I am not singling out Luizinho. Every minister, every MLA, every councillor, every sarpanch and a panch believes he can order the doctors around. To be fair to the doctors they are over worked and under paid. At the OPD the consultant often has to see between 60 to 100 patients. There is no way he can spend more than three minutes or even less with a single patient. And though all the doctors in the GMC hospital are part of the Goa Medical College they don’t even get UGC salaries. So much so an assistant professor in the University gets a higher salary than a Professor and HOD in the GMC.

GMC has the potential to become a first class medical institution. But this will happen only if the GMC gets full autonomy. And finds the right people to run it. The most important lacunae is the lack of the human touch. The total absence of communication. The denial of the right to information. In the soulless machine that the GMC has become there is nobody to guide or inform or ally the anxieties of either patients or relatives. And the fact that being a free hospital – though only in theory- doctors cannot be hauled up in the consumer forum encourages irresponsible beha-viour. Having said all that I would reiterate that GMC is still the best medical facility in Goa. But make sure that you know someone who knows someone. Not that being a VIP patient helps. On the contrary if you are a VIP or a VVIP you are at even greater risk. In an attempt to please you the GMC may well end up killing you. I can vouch for this. The GMC did not kill me. But it stole five years of my life because of a wrong diagnosis.

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