Kasaragod: The District Legal Service Authority (DLSA) -- appointed by the Supreme Court to provide an "objective assessment" of the healthcare facilities available for endosulfan victims in Kasaragod -- has exposed the half-truths dished out by the state government in the apex court.
The 34-page report, prepared by the DLSA secretary (sub-judge) Karunakaran B, said Kasaragod district lacked advanced diagnostics and super-specialist doctors and technicians.
Despite the change in names from primary health centres to family health centres and community health centres to taluk hospitals, all the centres and taluk hospitals in Kasaragod were providing only primary health care, said the report. They are plagued by inadequate human resources and diagnostic tools and equipment.
Health centres in endosulfan-affected areas did not have enough physiotherapists and palliative care nurses to cater to the needs of the patients. In most places, patients had access to a physiotherapist only once a month, it said. "That will not meet the purpose of the therapy," said the report.
Of the 17 hospitals empanelled for endosulfan-affected patients, only two are in Kasaragod: The District Hospital in Kanhangad and the General Hospital in Kasaragod. The two hospitals do not have super specialty doctors or facilities. Empanelled hospitals in Mangaluru are 70km to 100km away, and Kannur Government Medical College at Pariyaram is 60km to 90km away from affected areas, said the report.
Contrast this with the claims made by the state government in its affidavit submitted to the Supreme Court in July 2022. The government claimed it was turning the District Hospital into a super specialty hospital for neurology after appointing one neurologist.
To make light of the distance endosulfan patients travel to Kannur Government Medical College, it told the court that the hospital was only 22km from Kasaragod, counting the distance from the closest border to Kannur.
The government had even listed Kasaragod Medical College, which is under construction since 2014 at Ukkinadka, a border village in Badiadka panchayat, as one of the centres providing tertiary care facilities in Kasaragod district.
Why is the Supreme Court hearing the case?
Six years ago, on January 10, 2017, the Supreme Court ordered the state government to give Rs 5 lakh each to all the endosulfan-affected patients as compensation within three months. The same order also asked the state government to consider "providing medical facilities or treatment for life-long health issues, arising out of the effects of endosulfan".
When the government did not give out the compensation, four endosulfan survivors filed a contempt of court petition in the Supreme Court in 2019. The government managed to close the case by giving compensation only to the four petitioners.
When the government did not compensate the other victims, eight other survivors filed contempt of court petitions in the Supreme Court in February 2022.
The government asked the court to close the case after paying Rs 5 lakh each to the eight petitioners.
But the Supreme Court pulled up the government for sitting on the order for five years and asked it to pay an additional Rs 50,000 to each of the petitioners.
Instead of closing the case, the court decided to look into the second part of the 2017 order, which is on providing treatment to endosulfan victims.
After the state government's affidavit, the Confederation of Endosulfan Victims Rights Collectives (CERV), which is giving legal support to endosulfan victims, submitted a 'situational analysis of healthcare facilities in Kasaragod' puncturing government claims.
After two contrasting reports, the two-judge bench of justices D Y Chandrachud and A S Bopanna in August asked DLSA secretary B Karunakaran to file a detailed "objective assessment" report on the healthcare facilities, including palliative care and physiotherapy, available for endosulfan victims in the district.
Chief justice Chandrachud and justice P S Narasimha took up the contempt petition for hearing on January 2. They gave the DLSA's report to the state government and the petitioners and posted the next hearing to January 27. Onmanorama has a copy of the report.
As directed by the Supreme Court, DLSA secretary Karunakaran visited the medical college under construction and all the health centres and hospitals in the 11 endosulfan-affected grama panchayats to prepare the report.
The 11 affected grama panchayats are Kayyur-Cheemeni, Kallar, Panathady, Ajanur, Pullur-Periya, Muliyar, Badiadka, Karadka, Bellur, Enmakaje and Kumbadaje. The findings are not flattering.
Mobile medical units
A free mobile medical unit with a doctor and a staff nurse is run in the affected panchayats. It is funded by the National Health Mission (NHM).
But service is reduced to providing free medical aid to selected endosulfan victims at their doorstep once a month.
Ambulance service
Free transport is available to patients at all health centres to reach two empanelled medical colleges in Mangaluru and one in Pariyaram. But the vehicles are permitted to travel only up to 2,000km per month. So free transport is not made available to patients to reach hospitals in distant places, the report said.
Considering there is no tertiary medical care in Kasaragod district, many a time, patients have to travel to other districts.
Physiotherapy units
Almost all health centres in the affected grama panchayats have one physiotherapist each. But the number of patients requiring physiotherapy is too high and they only get access to physiotherapists once a month. When therapists go for house visits, there is no outpatient consultation at the health centres, said the report. "In many cases, patients' condition will improve only if there is daily therapy," it said.
They do not have access to physiotherapy equipment. The lack of physiotherapy machines and insufficient human resources are the major issues facing physiotherapy units, it said.
Palliative care
There is no exclusive palliative care for endosulfan survivors in the district. Nurses appointed on a temporary basis by the NHM and the local bodies have to take care of endosulfan patients and also general patients.
The health centres in affected panchayats have primary palliative care units but with only one staff. House visit is limited to once a month and is confined to supplying medicines and essentials such as diapers, protein supplements, pampers, checking blood pressure and sugar levels, wound dressing, and cauterisation.
Healthcare infrastructure
The community health centre at Poodamkallu in Panathady panchayat was upgraded to a Taluk Hospital.
It caters to 340 endosulfan patients in Panathady, 481 endosulfan patients in Kallar panchayat, 118 patients in Kodom-Belur panchayat, and 13 patients in Balal panchayat.
But the Taluk Hospital has only a "minimum facility" for physiotherapy. It did not have data on the special care given to endosulfan patients. There is no ICU or dialysis unit.
It provides only primary health care to patients, the report said.
The Taluk Hospital in Mangalpady panchayat does not come in the affected panchayat. But patients from neighbouring panchayats depend on it.
It has only a specialist doctor in medicine. It also provides no secondary care treatment.
The Taluk Hospital in Nileshwar has a specialist in medicine and a specialist in paediatrics. None of the three taluk hospitals attends to pregnant women or takes up childbirth cases because they do not have a gynaecologist. These hospitals do not even have labour rooms.
The gynaecologist of Nileshwar Taluk Hospital works from District Hospital.
The report said the taluk hospitals are not fit for secondary care.
Medical college is under construction
The government claimed that the medical college provides tertiary care. But the DLSA secretary reported that the hospital block is under construction. Against the sanctioned strength of 91 doctors, 15 specialist doctors offer outpatient consultations without any diagnostic tools on the ground floor of the academic block. "There is no other facility in the block," it said. The report also noted that the medical college is located on the border of Kerala and Karnataka.
The government inaugurated an incomplete Women and Child Hospital in Kanhangad in February 2022. It is not functioning. "Even basic amenities are not made available to this hospital building," the report said.
Tata Hospital in disuse
The Tata Trusts built a 550-bed hospital to quarantine and isolate Covid patients in September 2020.
It is made of 128 pre-fabricated shipping containers at a cost of Rs 60 crore. The two-year-old hospital has a "lot of issues in the structure such as leaking rooms, the durability of the floor built using plywood, and high risk of fire", the report said. "The cabin structure does not have a concrete basement either."
With no Covid patients, the machines, including the ventilators, remain idle. "Running the hospital in its present condition will be inconvenient and expensive."
District Hospital, General Hospital
The 400-bed District Hospital and 212-bed General Hospital are the only secondary care hospitals in Kasaragod district. The District Hospital has departments of general medicine, general surgery, gynaecology, paediatrics, orthopaedics, dental specialty, ophthalmology, and ENT.
But the departments of neurology and cardiology were not fully functional.
There is no neurosurgeon or radiologist in the hospital, the report said. There is no ultrasound facility. There is no technician to run the EEG (electroencephalogram) machine in the department of neurology. There is no trauma care facility in the District Hospital or the General Hospital.
The District Hospital does not have a urologist, medical oncologist, cardiothoracic surgeon, pediatric surgeon, or gastroenterologist.
The General Hospital has specialists in general medicine, paediatrics, dermatology, psychiatry, chest diseases, radiotherapy, and physical medicines. But there is no doctor to run the ultrasonogram. So pregnant women have to depend on private centres for scanning.
"There is a labour ward but the obstetrics and gynaecology wards are overcrowded. There were instances of keeping beds in corridors," the report said. The reason is the General Hospital in Kasaragod and the District Hospital in Kanhangad are the only two hospitals in the government sector attending to childbirth cases. No other government hospital in the district has a labour room.
Cancer treatment
General Hospital has a specialist offering outpatient consultation to cancer patients. But after diagnosis, the patients are referred to hospitals such as Malabar Cancer Centre in Kannur district or Regional Cancer Centre in Thiruvananthapuram, or other empanelled medical colleges, the report said.
Develop health care in Kasaragod
The government should complete the proposed medical college hospital at the earliest, said sub-judge Karunakaran as a solution to the problems facing the district.
He reasoned that the nearest empanelled hospitals in Kannur and Mangaluru are 60km to 100km from affected areas. The other empanelled hospitals are in Thalassery, Kozhikode, Angamaly, and Thiruvananthapuram.
The government may also establish multi-specialty tertiary care and trauma care at the District Hospital and General Hospital, the report said.
