It’s 3am and about 150 people are waiting outside the gates of the All India Institute of Medical Sciences. Each one desperate for his or her turn to meet a doctor at the Rajkumari Amrit Kaur out-patient department (OPD). The gates open, an hour later, and the patients and their family run towards the OPD, where guards reorganise them into queues. For the next five hours, they wait in queues until the OPD opens at 9am. One of the many problems plaguing India’s premier public hospital is overcrowding. As many as 10,000 patients reach the hospital’s OPD daily. In the absence of similar speciality hospitals, the super speciality AIIMS that was meant to be a tertiary car institution has become a primary healthcare centre for patients that throng it from all corners of the country. “Of the 150 people waiting outside the gates at 4am, only 80 are patients,” says Vishwas Kumar, 52, one of the guards at the OPD. “Card-making (registration) starts at 8.30am but the queues stretch up to the gates by 6.30am.
Each patient is usually accompanied with one or two people, but some have five or six attendants too, which results in overcrowding,” says Kumar. And the queue takes a toll on everyone. It takes months for even those with terminal diseases like cancer to get started with their treatment. Among them is Madhuri Devi, 40, who started her chemotherapy for cancer of the uterus in March 2014 after waiting for three months. “We queue up from 4am only to have the doctor tell us at 2pm that the radiotherapy machine is not working. He referred me to Safdarjung Hospital, where we were referred back to AIIMS because their machine is not working too,” says Madhuri, who moved from Bihar to Delhi with her husband last year to get treated. “I’m now queuing to meet someone who can tell me what to do next,” says Madhuri. Yasmeen Gohar, another cancer patient, had to wait nine months for her turn. “For eight to nine months, we could not get admission into the hospital, so I started chemotherapy at GTB hospital.
I’m finally back at AIIMS,” says the 28-year-old mother of four from Bihar, who is living in Ashok Vihar with her brother-in-law. A medical store supervisor told HT, requesting anonymity, that 75% of cancer deaths at the hospital are because of the long waits. “Many patients are turned away or given long dates because beds and radiation machines are booked. Since the poor can’t afford treatment elsewhere, they die waiting,” he said. Finding a shelter is another major problem that the patients who come from other states face. Many end up living on streets since the hospital dharamshala has limited occupancy and the administration does not allow anybody to stay beyond 15 days. The hospital has now started online appointments to check the problem of long queues at the OPD. “Since most of the overcrowding happens at the OPD, we have started online appointment for the already registered patients. We are also constructing two more halls where online kiosks and computer desks will be installed to help the patients track their treatment,” said Dr Amit Gupta, AIIMS spokesperson.
"Any hospital that gets close to 10,000 OPD patients daily is bound to be overcrowded. There are very few institutions of the calibre of AIIMS and hence the hospital gets patients from across the country, resulting in overcrowding," Dr Gupta said.The requested URL /index.php?option=com_content&view=article&id=740 was not found on this server. Additionally, a 404 Not Found error was encountered while trying to use an ErrorDocument to handle the request."The hardest button to press nowadays, is the 'logout' button," Indian Psychiatric Society president, G Prasad Rao, had said at an event in Madhya Pradesh in January. His words are ringing truer than ever now that the country's premier medical institution, the All India Institute of Medical Sciences (AIIMS) has started a special psychiatric out-patient department (OPD) for people who are addicted to the Internet, says a report in the Times of India. According to the report, the OPD has been opened for people — especially school and college students — who face serious mental problems because of excessive involvement with social media, online games and virtual reality.
The National Center for Biotechnology Information, US, defines cyber addiction as: "Excessive or poorly controlled preoccupations, urges or behaviours regarding computer use and internet access that lead to impairment or distress..." The TOI report mentioned that some people had become so addicted to the virtual world that they had lost interest in studies, human contact, and even hygiene. In February this year, two brothers aged 22 and 19 had been admitted to the Ram Manohar Lohia (RML) hospital in Delhi for urinating and defecating while playing games, because they couldn't even get away from the screen for a few minutes. Glued to their gaming consoles, the brothers had stopped doing their daily chores like studying, eating and sleeping. The addiction worsened when the two stopped using toilet and would defecate in their clothes while playing. With virtual reality consoles becoming more and more popular, people are often seen behaving in a manner totally unlike their usual behavioural pattern.
On Tuesday, The Sun reported that a woman had been "sexually harassed" in the virtual realm by a "pervert cyber-groper". The woman shared her experience in a Medium post:Even when I turned away from him, he chased me around, making grabbing and pinching motions near my chest. Emboldened, he even shoved his hand toward my virtual crotch and began rubbing. There I was, being virtually groped in a snowy fortress with my brother-in-law and husband watching."Cancer patients and their carers waiting outside AIIMS metro station. Many of them are here for an OPD visit. (Express photo by Tashi Tobgyal) Ram Gopal, a serving Border Security Force (BSF) personnel stationed in New Delhi, has been running from pillar to post at the All India Institute of Medical Sciences (AIIMS) for the past two months, seeking an appointment with the orthopaedic doctors for his spinal cord injury. After an agonising wait and battling the infamous OPD queues at the hospital, he has managed to get a date for his surgery: December next year.
The paramilitary person cannot afford to get himself treated at corporate hospitals and his hopes are thus pinned on AIIMS; a facility where the corridors are always crowded by patients, and most of them are from very poor economic backgrounds as they know this New Delhi-based hospital is the only place in India where they can get best treatment in very low expenses. Every day, hundreds of patients throng AIIMS and are kept waiting for hours to consult doctors. They start queuing up by 3 am in the morning, and those who fail to get-in, wait for the next day and the lucky ones move to the next queue. To put it in simple terms, getting an appointment with a doctor at this premier hospital is a daunting task for those who have tried their luck. However with the intervention of technology, the scenario is changing. Recently, as part of Prime Minister Narendra Modi’s Digital India initiative, the National Informatics Centre (NIC) has developed an online registration system (ORS) to book an online out patient department (OPD) appointment for various departments in the government-run hospitals across the country.
In the first phase of implementation, four major hospitals, including AIIMS have launched online appointment system for their OPDs and clinics. The new system has changed, to some extent, the overall experience of the people who are seeking appointments and the crowd management at registration counters for the hospital staff has also improved. “Earlier, people simply did not know the process. They were at the mercy of the touts and middlemen who managed the show outside AIIMS premises. And this led to a lot of corruption and leakages in the system. To have all these lacuna plugged, we have devised an online appointment system wherein any person irrespective of their region and nationality can book an appointment” Dr Deepak Agrawal, chairman—computerisation at AIIMS told FE. The use of technology is nothing new for some of the government-run hospitals. In fact, most of the tertiary and some of the secondary level government hospitals across the country have implemented hospital management information system (HMIS), a kind of hospital e-governance initiative, which integrates the entire resources of a hospital into one integrated software application for automating the back-end work-flow, ultimately leading to a paperless environment at hospitals.
But so far, none of them had a proper mechanism of an appointment system in place to eliminate long queues at the registration counters and validate the demographic details given by the patient to avoid duplicity of the records. “While there have been multiple efforts to address this; many public sector hospitals continue to struggle with patient work-flow issues. Many of these efforts are technology driven initiatives in various stages of implementation; and it’s going to be some time before we see widespread improvement across government hospitals,” says Utkarsh Palnitkar, a partner with KPMG India who also heads advisory and life sciences practices of the firm. “Having said that, it’s important to recognise that while technology can help address some of the work-flow related issues, it would not be enough to address the more serious concerns around significant shortage of clinical infrastructure and workforce in the country—a key cause of overwhelming patient footfalls, and long waiting times at many government hospitals,” he adds.
“At AIIMS, we receive about 9,000-10,000 patients per day and if you add two relatives to each patient, the number goes to 30,000 persons in a day—managing such a huge gathering is a humongous task,” says Dr Agrawal. “Only a technology-driven system could have streamlined the process of crowd management.” More than anything else, the new system at AIIMS has substantially reduced the waiting time; now a patient who comes with a prior appointment spends less than two hours at the hospital. Even for departments such as ENT, orthopaedics and skin care which once had a six-month waiting period, the waiting period has now been reduced to one and half months. At its core level, the online registration system is a cloud technology-based platform hosted at National Data Centre in Delhi. The portal has created a basic framework to link any government hospitals across the country to facilitate online appointments. So far, 11 hospitals have adopted ORS and in last five months they have seen over 82,000 online bookings.
The majority of patients—as many as 65,000—have sought appointments in AIIMS, followed by over 7,100 in Ram Manohar Lohia Hospital and about 5,600 in National Institute of Mental Health and Neuro Sciences, Karnataka. Dr Agrawal informs that the two ministries of IT and health & family welfare are collaborating to push all the states to adopt it. “They have agreed in-principle to implement it across all the AIIMS.” Giving a futuristic outlook, Palnitkar of KPMG India says, “Holistic improvement in public sector healthcare availability and accessibility in India is going to need well planned, coordinated action across multiple fronts. On one front, there is a need to relook at current operating models and increase adoption of information technology for improvement; on the other front there is a need for tightly coordinated action to address shortage of hospital infrastructure and clinical workforce, which have much longer lead times for development.” On the question of whether AIIMS is looking at any change in the new system, Dr Agrawal says, “We have many ideas and we are working around to bring new innovations to the system.