Petlwad NRC - Turning away patients

Wednesday I wrote about how Jhabua's NRC is 15 patients beyond capacity and Thandla's is 10 above. Today I visited the third NRC in Jhabua, Petlwad NRC which is a 10 bedded facility and one that will only accomodate 10 patients. Not one over. While the other NRCs in Jhabua make room for the extra patients, Petlwad's NRC is turning them away with promises for admission the next admission cycle.


Now, Petlwad NRC staff are not heartless and have their own constraints. The staff are following the directions from their superiors (not everyone is as headstrong as my friend Heena at the Jhabua NRC). They were convinced they would get in trouble for admitting a child over capacity or off cycle. This block level hospital is not as well equipped and does not have as much extra space as Jhabua's district hospital. The NRC is a small building tucked in the back of the hospital campus. Theres no room for spillover patients in the hospital's pediatric ward or other wards. There doesn't seem to be strong committment from hospital in-charges (whom I've interacted with before).

I understand all these limitations, but regardless, this is not right. This NRC "waiting list" has disasterous consquences. A patient should never be turned away from treatment.

I have experienced multiple times the incredible challenge that all health workers face in the field of trying to convince a mother to take her child to an NRC. These centers are sometimes hours away in a non-familiar setting, often a district hospital where tribals are often treated poorly. They have to spend 14 days at this center while missing out on key responsibilities at home. While they receive 65 inr a day in wage compensation, this often does not make up for the farming work they are missing, or tending to their livestock, or feeding their other children or their demanding husband. "What, I'll go to the NRC with this child and the other children will become malnourished," one mother told me.

I've failed many times to convince a mother to go to the NRC. And I don't blaim those mothers. I wouldn't want to spend 14 days at an NRC, even the best ones I've seen.

So despite all odds and challenges, if we finally get a mother to agree to bring her child to an NRC and they gets turned away from treatment. We've lost her and quite possibly her child.

This is why we need village based treatment for uncomplicated cases of severe acute malnutrition. While I didn't see the children turned away, I'm sure they weren't extremely complicated cases on the verge of death (I really hope not, the Petlwad staff assured me a complicated case would be referred to Indore). These children who were turned away would be perfect candidates for Ready to Use Therapeutic Food (RUTF) - a supplement medically and nutritionally equivelant to the one given at NRCs, but without the risks of contamination associated with milk/water based products (see September 16th post for a detailed explanation of RUTF). This take-home treatment, however, is not approved for use in India because of politics.

What do we do?

While we're sorting out the RUTF issue, we have to make NRCs work and add more since even when RUTF is introduced, we'll still need functioning NRCs for complicated SAM cases. To start with in the Petlwad case, they do have 4 staff members for 10 patients. There must be a way for them to accomodate more patients. With a little pressure from the community, maybe the in-charge will sacrifice his big office? Maybe the hospital staff could sacrifice their breakroom? I'm no expert in hospital administration, but surely they could find away. I'll be raising this in Bhopal.