Kasaragod: On September 9, 2020, the Tata Group gifted India's first Covid hospital built from scratch to Kerala.
It built the 551-bed hospital in five months using 128 prefabricated shipping containers at Thekkil near Chattanchal.
Inaugurating the hospital, chief minister Pinarayi Vijayan said the Tata Group invested Rs 60 crore to build the structure. The Covid hospital will be an asset to Kerala's healthcare sector and to Kasaragod, where there is no tertiary healthcare facility, Pinarayi Vijayan had said.
After two years and four months, Vijayan's health minister Veena George said the state government is considering dismantling the structure. A technical team would be appointed to take a call on the structure, she said at a review meeting with the five MLAs of Kasaragod district held at the Mini Civil Station in Kanhangad on January 12.
But later speaking to reporters, she said the containers would not last long and they might be dismantled.
She also said the government would take immediate steps to set up a speciality hospital at the site.
Udma MLA C H Kunhambu said he would recommend the release of Rs 1 crore from his Asset Development Fund if the government went ahead with the proposal to build a speciality hospital.
'Tata's containers inconvenient for a hospital'
Two things are at play here. One is the quality of the hospital built by the Tata Group. Two, whether Kasaragod needs another building in the name of speciality care?
Tata Projects, which built the hospital, said the shipping containers had a life of 25 to 30 years, provided they are maintained.
But in less than three years, the Rs 60-crore facility has been marked as junk.
In a recent report to the Supreme Court, the District Legal Service Authority secretary Karunakaran B pointed out the leaking rooms, the durability of the floor built using plywood, and the high risk of fire".
The containers do not have a basement either.
When this correspondent visited the hospital, the staff showed how the water was leaking through the ceiling. If the wind blows, the rainwater would be swept inside the containers through the door and corridors.
A doctor said water streamed through the power points in the containers. "The fear of a short circuit was real," she said.
Karunakaran wrote in his report that "running the hospital in its present condition will be inconvenient and expensive".
Several doctors are questioning the logic of investing Rs 60 crore in the container-based hospital.
"Rs 60 crore means each of the 128 shipping containers is worth around Rs 46 lakh to Rs 47 lakh," said a doctor, who was part of the district's Covid management. "And for Rs 50 lakh, we can accommodate only three to five patients in a container," he said.
A container is 40 feet long, 10 ft high and has a width of 10 feet.
A container -- if it is an isolation ward -- has three independent rooms with attached bathrooms. For quarantine wards, each container has five beds with an attached bathroom.
The 128 containers were spread over an area of 1.84 acres or 80,000 sq ft. "We need three times more staff to manage patients in such a sprawling campus than in a vertical building," said another doctor. "But it was built as an isolation and quarantine facility during a pandemic. So we cannot compare it with a regular hospital," he said.
To be sure, the state government invested around Rs 15 crore to build an approach road to the hilltop hospital, an uninterrupted power supply, and sewage management. It also provided 5 acres for the project.
Wanted specialist doctors, not speciality hospitals
But politicians and doctors slammed the government's plan to build another hospital block in Kasaragod when the district is plagued by a lack of human resources and not building.
"We don't need another hospital building. We need doctors in existing hospitals in Kasaragod," said an office-bearer of the Kerala Government Medical Officers Association.
Kasaragod MLA N A Nellikkunnu said if the government had money to build another hospital, it should invest it in completing the medical college hospital block at Ukkinadka in Badiadka grama panchayat.
"The work on the hospital block is held up because the government has not paid the contractor around Rs 8 crore. The contractor has approached the high court demanding his bills be cleared," said the three-time IUML MLA.
Kasaragod Lok Sabha MP Rajmohan Unnithan said the health minister fooled people every time she came to Kasaragod. "Last time she was here, she said the Woman and Child Hospital would be inaugurated soon. This time, she said the hospital would be opened in March. But to start a hospital, she has to first appoint staff, at least a superintendent," the Congress MP lamented.
The MP was referring to the Woman and Child Hospital at Kanhangad, inaugurated by Veena George's predecessor K K Shailaja in February 2021, just ahead of the assembly elections.
That was the only day the hospital was open to the public.
Woes of Taluk hospitals
Kasaragod has five taluk hospitals. They are at Nileshwar municipal town, Poodamkallu in Panathady panchayat, Mangalpady panchayat, Bedadka panchayat and Trikaripur panchayat. "They are supposed to be speciality hospitals. But the government does not appoint specialist doctors and run them as primary health centres," said an office-bearer of the Kerala Government Medical Officers' Association, a collective of government doctors.
To be sure, the District Legal Service Authority (DLSA) secretary (sub-judge) B Karunakaran visited the taluk hospitals in Nileshwar and Mangalpady and found them unfit for secondary care.
According to the government's staffing pattern, a taluk hospital should have at least 128 employees, with 40 nurses and 23 specialist doctors.
The pattern says there should be four specialists in gynaecology & obstetrics, four paediatricians, two anaesthetists, three specialists in general medicine, two general surgeons, two orthopaedic surgeons, and one specialist each in ENT, pathology, dermatology, physical medicine & rehabilitation, and psychiatry, and one dental surgeon.
None of the taluk hospitals has anaesthetists, so they do not take up childbirth cases or conduct surgeries.
The taluk hospital in Trikaripur has only one paediatrician and one gynaecologist, who offer outpatient consultations. It does not even have a casualty wing because all four posts of casualty medical officers are vacant.
The taluk hospitals in Nileshwar and Poodamkallu have a general medicine doctor and a paediatrician. The taluk hospitals in Mangalpady and Bedadka are run by a lone general medicine doctor.
"The government should focus on strengthening the hospitals in the periphery so that the pressure on the District Hospital can be eased. But the focus of the government is on civil construction," said a senior health official in the district.
To be sure, none of the taluk hospitals in Kasaragod district attends to childbirth cases, stretching the resources in General Hospital and the District Hospital.
The DLSA report to the Supreme Court said the obstetrics ward was overcrowded. "There were instances of spreading the beds on the veranda for want of space," it said.
Focus on infra, not human resource
The General Hospital in Kasaragod does not have specialist doctors in cardiology, nephrology, gastroenterology, and surgical super speciality.
There is an EEG machine installed in the department of neurology, but there is no technician to operate it.
Similarly, the General Hospital has an ultrasonogram, but no doctor to run it.
The government spent Rs 9 crore to set up a catheterisation laboratory or cath lab in the District Hospital. It was inaugurated by Shailaja on the same day the Women and Child Hospital was inaugurated before the election in February 2021.
Till now, the government has not appointed staff in this facility and the lab is in disuse.
Procedures such as angiogram, angioplasty, and implantation of pacemakers and cardioverter defibrillators are carried out. A cath lab is led by a cardiologist.
The Kasaragod District Hospital does not have a forensic surgeon. General Hospital has one and is expected to do post-mortems day and night.
There is no doctor for radio diagnosis in the entire district. The District Hospital does not have a urologist, medical oncologist, cardiothoracic surgeon, paediatric surgeon, or even a gastroenterologist.
Kasaragod residents depend on hospitals in Mangaluru and Kannur and Kozhikode for tertiary care.
Building blocks
The District Hospital has a new five-storey unused building constructed close to the District Jail. The building has not got security clearance.
The General Hospital also has a new eight-storey block built for Rs 8 crore. "But nowhere is the government appointing staff. If only the government appointed doctors in our hospitals, it could have changed the face of Kasaragod's healthcare sector," said a KGMOA member.
