 "With digitisation, AIIMS tries to heal a broken system")
Mohammed Mushtaq can manage a wry smile even amid deep despair. Ahmed, his six-year-old son, runs around his father in circles, often grabbing his shirt and breaking into a shriekish laugh. His wife stands next to him, motionless. "Just four and a half months," Mushtaq tells me, brandishing four fingers of his right hand.
Ahmed probably doesn't know why his parents have been frantically roaming the glutted corridors of the All India Institute of Medical Sciences (AIIMS) for the last 15 days.
Ahmed has a tumour in his brain. When he was taken to the doctors after regular bouts of fainting back home in Purnia, Bihar, they recommended that Ahmed undergo surgery immediately. "It took us more than 10 days to just see the doctor at AIIMS, despite this being given emergency priority," says Mushtaq.
The appointment process he confesses, however, was less cumbersome than he expected. "I always knew it would take long. But getting an appointment, surprisingly, wasn't that difficult."
In his Independence Day speech from the Red Fort, Prime Minister Narendra Modi spoke about how the country's premier medical institution has been able to transform itself through a slew of measures adopted in the last one year.
"Just remember the times, when if we had to go to any big hospital, we had to wait for many days. When people used to come to AIIMS, they had to wait for two to three days to just know when they will have to undergo the tests. Today we have been able to change the entire system. There is an online registration, online appointment of doctors, and when the patient comes at the time given to him, his treatment starts," said Modi.
Modi's words of praise must have come as music to the ears of the administrators of a hospital, which has been plagued by a variety of issues over the last couple of years: high inflow of patients, a deplorably skewed doctor-patient ratio, charges of corruption, nepotism, and a failure to retain top talent.
These are only some of the major factors that have healthily contributed to its status of being an outdated and ailing medical model. On Saturday, a dispute reportedly broke out between resident doctors and nurses over the collection of patients' blood samples.
"AIIMS has faced problems on so many levels in the last few years. The administration has been a mess, and the dealing with so many patients is a headache that no one seems to have answers to," says Rajiv Chaudhary, a general physician who runs a clinic in Delhi.
However, under Union Health Minister J P Nadda, the government has been making conscious efforts to resurrect the institute's image, among which the attempt to digitise patient records and the doctor appointment process was initiated around 13 months ago. "Digital India is the Prime Minister's dream. Moreover, this has helped make the doctor-patient interaction faster and more efficient," says a health ministry official.
Scenes of chaos
On a bright Thursday morning, outside AIIMS is the usual thick crowd of people. The smell of beedi hangs heavy in the air near the entrance. Commuters haggle furiously with autowallahs, even as cars behind them blare their horns incessantly in a quest to meander through this busy crossing. More people make their way to the entrance after buying medicines from chemist shops across the road.
Outside the main web centre - several other kiosks have been set up - Hitesh Kumar is having one of his terribly busy days. Patients come up to him with slips of paper and quiz him on myriad things, including the dates of their appointment, and more infuriatingly for Kumar, the way to the loo. "It's not as busy as Monday. That can kill you," he laughs.
Kumar is a volunteer at this web station at AIIMS. He helps visitors feed in their Unique Health Identification Card (UHID) - which takes at least a couple of hours to obtain - and get an appointment.
Inside the room, the two air-conditioners keep the environs cool, as volunteers boringly stare at computer screens - this centre has about 10 - around them. Behind them, a long queue of patients waits in readiness.
"There is no denying that the system has become more efficient. Earlier, there were people everywhere and no sense of organisation," says Kumar. "Now, with online registration, managing the crowd has become easier. Moreover, this has helped eliminate brokers, who would take money and help you get an appointment."
Kumar and his team attend to more than 1,000 visitors every day.
He, however, adds that despite the setting up of a number of kiosks, only a couple of them are fully utilised. "Some people are technologically handicapped. The others just don't want to do it themselves. The kiosks that do not have any volunteers are completely empty."
People like Mahendra Yadav, who has come here from Ghaziabad to get himself treated for a liver ailment, are perhaps the reason for such a trend.
Sitting cross-legged on a pavement, Yadav is having a meal of dal and rotis. "I tried understanding how this works. But I just cannot use the internet," says the 38-year-old. Instead, he stood in a queue for two hours to get an appointment. The online process, on the other hand, takes merely 15 minutes.
Other patients say that people getting into a queue in the wee hours of the morning just to get their hands on an Out Patient Department (OPD) card is now a thing of the past. "They still do get here at 4 am for some departments, but otherwise, that is no longer the case," says Kumar.
Repeated requests for a comment from AIIMS officials did not elicit any response.
Burdened by numbers
Former AIIMS doctors conclude that the smoothening of the preliminary patient process was a must but problems still persist.
S K Kacker, former AIIMS director, says that the health minister must be lauded for this transformation push. "Things have definitely improved. There are more volunteers, better service and efficiency."
For the main problem to be solved, however, there is a dire need for a major overhauling of the system. "At the end of the day, the number of patients is only going up. We cannot control the huge number that comes to AIIMS. Digitisation can speed up the process but not solve the problem," explains Kacker, who retired from the job in 1995.
Sumeet Khanduja, an ophthalmologist who worked at AIIMS for eight years, adds that getting an OPD card easily doesn't change anything for the doctor. "An OPD card or a quick appointment makes it easier for the patient. But the doctor is treating the same number of patients. He is human, after all," says Khanduja.
Both Kacker and Khanduja touch upon a problem that AIIMS has been grappling with for several decades: an astronomically high patient inflow. More than three million people come to AIIMS every year, easily the most for any hospital across India.
A doctor, on an average, looks at 100 patients every day. And, the situation is far worse in the emergency department, where 13 of the 20 posts for senior resident doctors are lying vacant.
Waiting periods for an appointment, too, continue to be painfully long. If you want to meet a doctor in the department of cardiology, for example, your chance will only come in early October. Similarly, if you want to get a skin problem treated, a doctor at the department of dermatology can only meet you in the middle of November.
"The wait is the worst. It is far too long," says Suman Lata Devi, who has arrived here only this morning from Bulandshahr. "And, sometimes you miss your appointment by five minutes, and then you have to wait for another three months."
Meanwhile, Mushtaq and his family remain optimistic about Ahmed's chances. They are willing to wait an extra couple of weeks for AIIMS to grant them a slot for the operation. "I visited G B Pant Hospital, too. But then people told me that AIIMS can treat Ahmed best."
Ask him if he has ever lost patience in his arduous fight, Mushtaq simply smiles. "How can you blame the hospital? So many people need treatment. Ahmed has four months; someone else may have even less than that."
