Critical shortage of human resources force Ob-gyn specialists to play it safe

Obstetricians and gynaecologists in the State are engaged in a quiet rebellion . They have decided to “take a step back” from conducting deliveries in public hospitals that lack adequate human resources, facilities and infrastructure, ensuring obstetric emergencies are handled only at tertiary care centres .

In fact, in Thiruvananthapuram district, Ob-Gyn specialists have already started implementing this protocol, a joint decision that was taken by them in consultation with their fraternity as well as the Kerala Government Medical Officers’ Association

Over the past two weeks, in institutions where there are just two Ob-gyns and no resident anaesthesiologist, doctors have stopped conducting deliveries and related surgeries after duty hours.

Ob-Gyn specialists point out that every time unexpected complications arise during a delivery, they are targeted for “medical negligence”. The incident at Nedumangad hospitaI (wherein the Ob-gyn doctor was blamed for the death of the new-born) is the latest in a series of incidents, wherein the mob turned on the doctors.

Though the enquiry report later found the doctor to have followed all protocols, the violence that the doctors face as well as the apathy of the authorities seem to have prompted doctors to adopt the hardline stance.

“There are several delivery points in the public sector where we do not have adequate number of Ob-Gyns, anaesthesiologists, support staff or blood storage facilities so that we can provide 24×7 delivery care. Obstetric emergencies happen out of the blue and often, one Ob-Gyn ends up handling these high-risk situations, which sometimes do not end well. The authorities are aware of the situation but still they expect us to provide comprehensive emergency obstetric care in these institutions,” N. Sunitha, president of KGMOA Thiruvananthapuram, says.

Ob-Gyns have decided not to take anymore unnecessary risks. In Thiruvananthapuram, there are at least four delivery points — Poojappura, Fort hospital, Attingal and Parassala taluk hospitals — where the situation is not conducive for providing round-the-clock service. In a few places like Vithura, Neyyattinkara, Chirayinkeezhu and Varkala, there are two Ob-Gyns each but the anaesthesiologist on call has to provide service to all departments and may not always be available. “We are telling patients ahead that we do not have the facilities to give proper care 24×7 and they get referred to higher centres. No deliveries will be conducted in these institutions after duty hours, because doctors are no longer willing to put their career or lives at risk,” Dr. Sunitha says

At present, it is only in Thiruvananthapuram that Ob-Gyns have taken an official position not to conduct deliveries where 24×7 facilities as per standard protocols are not available. But KGMOA has prepared an entire zone-wise list of delivery points across the State where comprehensive emergency obstetric care is impossible and where Ob-Gyns are working under severe stress

“Safe motherhood is often taken for granted, but there are innumerable issues that can suddenly complicate what familied expect to be a ”normal” delivery. But people are not willing to accept this reality. Doctors, especially Ob-Gyns, now work under severe stress and threats of litigation, violence, and media trials have compelled them to play it safe,” says Subhash Mallya, Secretary, Kerala Federation of Obstetrics and Gynaecology.

KFOG has been conducting a lot of public sensitisation programmes to highlight the uncertainties in obstetrics but doctors continue to be penalised for anything that goes wrong.

Ob-Gyns have now officially communicated to the Director of Health Services that obstetric emergency service can be provided only in places where experts are available round-the-clock.

One option would be to create select delivery points in districts, where such facilities and human resources can be made available 24 x 7, where all deliveries can be conducted safely.

They have also requested that a team of experts be deputed to conduct an assessment of the current delivery points in the State so that it can be determined whether these places are safe for providing comprehensive obstetric care as per standard protocols.