On Shaky Ground, Joshimath CHC’s Emergency Wing Needs Immediate Care

By Satyam Kumar

Joshimath (Uttarakhand): Nestled in the foothills of Himalayas, Joshimath Community Health Centre (CHC) in Uttarakhand’s Chamoli district seems like any other public facility from a distance. But not all is well with the building, where cracks that surfaced over two years ago are slowly expanding.

Joshimath has been recording fresh incidents of land subsidence since October 2021, which has had an impact on the buildings and roads in the area.

Fissures badly splayed an adjacent building catering exclusively to emergency cases last December at a time when the Joshimath issue made headlines across the country. The 10-bedded unit had to be shifted to a small room in the CHC’s main building, which is located at a higher position. However, health staff face challenges at the new premises as space constraints make it difficult to accommodate necessary medical equipment.

As many as 56 medical staff, including nine doctors, are employed at the CHC which caters to health needs of people in 58 gram sabhas and Joshimath town. Around 80 patients visit the facility daily. That number can go up to 150 during tourist season and winters when it snows in Auli, a hill station nicknamed ‘Switzerland of Uttarakhand’ and located just 13 km from Joshimath.

Being the last major town on the Indo-Tibetan border, Joshimath serves as the gateway to Himalayan expeditions and pilgrimages. Be it a visit to Sikh holy site Hemkund Sahib, Auli, or Valley of Flowers National Park, Joshimath is an important location for all pilgrims and tourists.

The Badrinath shrine, one of the Chardham pilgrimage sites, is located 43 km from Joshimath. With the Chardham Yatra set to commence on April 27, providing 24×7 health services is of paramount importance.

Explaining the need for a full-fledged emergency unit in the town, Dr Gautam Kumar Bhardwaj told 101Reporters that lack of oxygen was one of the common problems faced here.

“One feels tired and breathes heavily. Blood circulation slows down. The risk of brain haemorrhage and heart attack also increases. For diabetes patients, lack of oxygen can be fatal due to the sudden surge in blood sugar level. In such cases, the patient first needs oxygen, which is available 24 hours at our CHC.”

The facility has a major role to play in the lives of local people too. As many as 19 health sub-centres function under the CHC, but they don’t have in-patient facilities or labour rooms. Pregnant women from all sub-centres are dependent on the CHC for delivery as there are no private hospitals equipped with this service. The hospital nearest to Joshimath CHC is the District Hospital in Gopeshwar, located 60 km away.

Labour Pangs

Ultrasound facility is present in only a few CHCs of Uttarakhand. Sadly, despite being a vital resource for people in the difficult terrain, Joshimath does not have this facility for the last few months after the machine operator was transferred.

Though seven months pregnant, Karishma Devi was yet to get an ultrasound done when 101Reporters met her. Generally, doctors suggest ultrasound screening every three months of pregnancy to assess the child’s growth.

“In the CHC, there is nobody to operate the ultrasound. It costs more than Rs 1,500 in a private facility. My husband is a labourer. Our six-member family already faces difficulties in meeting food-related expenses. So we have decided to get it done only in the ninth month,” Karishma said.

There are other problems as well. Social activist Jitendra Rautela said Usha, who lives near his home in Joshimath, went into labour around 1.30 am on January 26. When she was taken to the CHC, the doctor referred her to the District Hospital citing possible complications. However, Usha had a normal delivery at Gopeshwar, after travelling almost three hours.

“The state of affairs in the CHC is evident from the fact that referrals have become so common,” Atul Sati, the convenor of Joshimath Bachao Sangharsh Samiti said. However, Dr Bhardwaj claimed the CHC admitted women if it seemed to be a normal delivery during their check-ups.

“We refer a woman in labour to the district hospital only after assessing the possibility of a Caesarean section (C-section). As for the ultrasound, we send the women to Gopeshwar at the expense of the CHC,” he claimed.

At the time of writing this story, about 70 pregnant women were enrolled at the CHC. To ensure safe deliveries, three CHC ambulances and one 108 service ambulances have been deployed round the clock. Arrangements have also been made to shift the new mothers directly to the Sub-District Hospital in Karnaprayag or the District Hospital, in case of an emergency.

Meanwhile, land subsidence has affected many pregnant women. “Those displaced due to cracks on their houses have been sent to live with their relatives to ensure that they get proper care,” said Joshimath block ASHA coordinator Anita Pawar.

Alarm Bells

At present, the displaced families live on rent in hotels or houses that have not developed cracks. Indresh Maikhuri, a social worker and key activist of Joshimath Bachao Sangharsh Samiti, said several sit-in protests have been organised in the last few months, but both the Uttarakhand and Central governments have not come clear on compensation, rehabilitation and reconstruction.

“Only statements that the double-engine government will devise the best policy for Joshimath make the rounds. There is no trace of the policy even after so many days,” he lamented.

When it comes to the CHC, better facilities to deal with untoward incidents are the need of the hour. Upgrading the hospital to a First Referral Unit with facilities for C-section deliveries and 24-hour surgical emergencies will save lives as taking the patients to Gopeshwar means wasting three precious hours.

Even the CHC ambulances are in a state of disarray at present.

On February 28, two persons died and seven others suffered injuries when an SUV fell into a gorge on the Joshimath-Thaing route. A CHC ambulance was despatched to transport the injured. However, following its breakdown, another ambulance and private vehicles had to be deployed. When they finally reached the CHC, there were no vacant beds to accommodate them.

At that time, Facebook videos of a fracas between the relatives of accident victims and hospital staff over the lack of facilities also surfaced. However, hospital staff were not ready to speak about the incident and issues leading to it.

Right now, there is no clarity on what will happen if minor cracks on the CHC’s main building get bigger in the near future. The hospital authorities did not respond to queries on where the CHC services will be moved in such an eventuality. Efforts to get in touch with Dr Rajeev Sharma, the Chief Medical Officer for Chamoli, also proved futile.

(Satyam Kumar is an Uttarakhand-based journalist and a member of 101Reporters, a pan-India network of grassroots reporters)