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India health: Spit and polish?

At India's most renowned hospital spitting is ubiquitous and, potentially, dangerous.

A woman washes her mouth outside her shack near Bhavnagar, in the western Indian state of Gujarat March 5, 2009. (Arko Datta/Reuters)

NEW DELHI, India — New Delhi's All India Institute of Medical Sciences (AIIMS) is, arguably, India's best hospital.

But even though patients travel for hours – even days – to seek treatment here, they don't show the same respect inside its hallowed walls. A new survey shows that a whopping 90 percent of them spit inside the hospital building, raising the risks of dangerous hospital-acquired infections like tuberculosis, pneumonia, and swine flu.

Most hospital acquired infections are spread by indiscriminate spitting, concludes the survey, which was conducted by the Department of Neurosciences at AIIMS. The study found that attendants were even spitting in the corridors outside the ICU and isolation wards.

In other words, if you weren't sick when you got here, you might be when you leave.

“When we looked at the reason for spitting, about 80 percent said it was a habit, and about 16 percent said it was because they chew betel nut and tobacco,” said Dr. Manjari Tripathi.

Near the entrance to the outpatient department, as security guards move along the pavement, rousting patients camped here to await treatment, the challenge of keeping the premises clean becomes clear. Here and there patients and their families have set up impromptu picnics. In one corner, a man with a catheter restlessly shifts his bag of milky urine out of the sun next to a huge, blue signboard that is surely unintelligible to him. IMPORTANT NOTICE, it reads:

1. PLEASE PUT THE WASTES INTO THE DUSTBIN ONLY.
2. SMOKING USAGE OF TOBACCO, PAN MASALA ETC. ARE BANNED IN THE AIIMS HOSPITAL PREMISES AND IT IS PUNISHABLE IF FOUND GUILTY.
3. DO NOT SPIT IN THE HOSPITAL PREMISES.
4. GIVING FOOD TO MONKEYS AND DOGS IN THE HOSPITAL PREMISES IS STRICTLY NOT ALLOWED

Most of these people camped on the pavement are villagers. Uneducated and living hand to mouth, they've traveled for eight hours or more to get here, and after the guards kick them out they'll find a place on the median or beneath an overpass to spend the night until the hospital reopens in the morning.

“Of course the people are spitting here and there,” says 60-year-old Khajan, a villager who has traveled for five hours on local buses, only to face a long day of waiting for a doctor. “What difference does it make?”

That kind of apathy from patients who have bigger problems is only one of the challenges AIIMS faces.

http://www.globalpost.com/dispatch/india-health-hospitals