Ayurvedic doctors performing post-mortems and allopathic doctors reusing disposble syringes are a common scene in the primary health centres (PHCs) in the western Indian state of Maharashtra.
Barely 62 km northeast of Mumbai, India's commercial metropolis, Dr Ishwar Thite is busy, handling nearly 80 patients and conducting four deliveries on an average day. And, he also handles an occasional autopsy.
"Since the health centre is on the highway, accident cases regularly come in. I'm the only doctor to conduct the autopsy here," he said. Questioned on his expertise, he quickly replied: "We had studied it for three months in our college."
Dr Thite, though, doesn't remember conducting even a single autopsy in his college. His medical qualification — Bachelor of Ayurvedic Medicine and Surgery (BAMS) — entitles him to prescribe allopathic medicine only when no ayurvedic remedy is available for a particular condition. For him to conduct autopsies is not permissible.
The officialdom initially denied such things were happening. "Ayurvedic doctors cannot perform a post-mortem, no way, we don't allow that," P.P. Doke, Director General of Health Services, told the Hindustan Times.
But when the newspaper's correspondent insisted that he check it out for himself, minutes later, Doke came back, blushing. He admitted that such a thing was indeed taking place right under his nose, without his knowledge though.
"But then, you see, we had allowed ayurvedic doctors to conduct post-mortems 25 years ago, when they had an integrated course. But about 99 per cent of these doctors have retired and the present batch isn't supposed to do autopsies. I've just learnt about it and will now look into it," he explained.
Forensic science experts were shocked. "Only MBBS graduates can conduct post-mortem. How can ayurvedic doctors do it?" asked police surgeon Dr S.M. Patil in dismay.
The ayurvedic doctors still in service sought to reassure inquisitive scribes that there was nothing at all to worry. "I know we aren't supposed to do autopsies alone, so I either call an MBBS doctor from the nearest hospital or send the bodies there," said Dr A.R. More from the health centre in Shenva which covers some tribal villages around 85 km from Mumbai.
"We are allowed to do accident cases. But for more complicated cases like burns or murder, we take the help of an MBBS doctor," said medical officer R.N. Rathod from Khardi, 95 km out on the Mumbai-Nashik highway.
If in such situations the inadequately qualified doctors could pose a risk to patients, the state seems to be putting the doctors at peril in turn. For surgical gloves are missing, so are basic medical instruments like forceps and needle holders needed to suture wounds.
"There is always a shortage of gloves. We use them only in emergencies. There is an acute water shortage so sanitation is an issue. There is a perennial shortage of needles, suture material, anti-fungal creams and basic drugs, but we have learnt to manage," said
Dr Mohan Waghmare, medical officer at the primary health centre in Kasara, a one-and-a-half-hour train ride and a short rickshaw ride away from Mumbai.
Hindustan Times also reported that basic emergency medicines for cardiac arrest or hypertension were missing, and so were ambulances and drivers.
Besides, many staffers are dumping bio-medical waste in trash bins, ignoring several directives. "It is for the government to provide us other feasible means of disposing the waste," say the PHC staff in their defence.