Palakkad: What frustrated a socially-committed surgeon like Dr Haris Chirackal, the Urology head of Thiruvananthapuram Medical College, is the labyrinthine bureaucratic processes that unnecessarily delays the purchase of critical surgical instruments. But along with systemic issues, negligence, too, plague Kerala's public health system.

Four years ago, administrative callousness had put out of use a state-of-the-art portable digital X-ray machine in the Palakkad District Hospital. The machine that cost nearly a crore (₹92.61 lakh) was offered free of cost by Samsung as part of the company's corporate social responsibility initiatives.

The portable X-ray machine was installed at the hospital during the height of COVID, on July 16, 2021. Though the quality assurance test was done swiftly, on July 21, the machine was still not put to use. Barely three months later, on October 6, the wires of the unused machine were seen chewed apart by rats. But the rat-eaten X-ray machine remained a secret.

It would have remained so had it not been for the pandemic. "During COVID, private labs were put under severe restrictions and people flocked to the Palakkad District Hospital. It was then that we got information about an X-ray machine that was left unused in the hospital. Some of the nurses told us that the crowd could be better managed if this X-ray machine was also made operational," said Boban Mattumantha, a public activist who dug up the truth about the machine.

The advantage of a portable machine is that it could be taken to the patient's bed, saving the old and the weak the torture of having to plod all the way to the X-ray room and wait endlessly in queues.

Initially, Mattumantha was lied to. "I was told that all machines in the hospital were functioning properly," he said. He then took the RTI route and, simultaneously, petitioned the top health officials right up to the health minister. He wrote to the health minister twice, and eventually a probe was conducted by the district medical officer in August 2022.

The DMO's report confirmed 'rat bite'. Yet, there was no mention in the report of the hospital conditions that made it easy for rats to play havoc with a top-rated X-ray machine. Instead, it blames Samsung for the equipment lying unrepaired.

The report states that Samsung first quoted ₹96,519 for repairs. Since the spare parts had to be secured from Korea, there was a delay. Then, seven months later when the Samsung team did a second check-up of the machine, the quote was raised to ₹31.91 lakh. The hospital refused to pay.

Fact is, Samsung is under no obligation to mend the machine. A formal agreement drawn up between the hospital superintendent and Samsung says that the product warranty of two years does not cover "defects caused by rats, cockroaches or any other animals or insects".

The safety of the machine was the hospital's responsibility. Under the hospital-Samsung agreement, it was the hospital's task to bring up the quality and safety of the storage room to the standards required for a technically advanced product.

"Hospital shall provide and renovate the infrastructure of the identified room," Clause 3 of the agreement says. It says further: "Renovation may include interior and exterior wall repair and painting, flooring, ceiling, electricity conduits, new furniture and similar changes. Furthermore, any infrastructure upgrades required to such rooms to meet requirements as per medical practices such as lead glass, lead coating and lead walls in these rooms will be undertaken by the hospital itself at its own cost."

Nothing was done. Even then the DMO's report had no mention of the hospital's failure to adhere to the conditions laid down in the agreement signed between the hospital superintendent and Samsung.

Mattumantha is amused by the health department's thinking that the destruction of a costly and brand new X-ray machine by rats has nothing to do with administrative inefficiency. "It is the department that issues advisories on how to avoid rat fever and here the negligence of hospital authorities has allowed rats not just to swarm the hospital floors but also feast on the wires of an X-ray machine," Mattumantha said.

His constant petitioning had set in motion a Vigilance probe in 2023, but it has not reached anywhere. "I am told the Ernakulam unit of the Vigilance had collected relevant documents from the hospital. But till now they have not taken my statement," Mattumantha said.