Recently Hidden Pockets set out to find different sexual and reproductive health (SRH) services in the city of joy, Kolkata. A primary research of the different health services provided in the city was done before the mapping exercise was undertaken. This research included Internet research and conversations with different individuals, activists and organisations working in the space of public health. The research showed that the status of public health services was inaccessible, unhygienic and crowded. So we decided to picked out a few of the available public health service providers in the city to understand the state of SRH services in the city. Since Family Planning Association of India (FPAI) usually features on our list of recommendations in the cities that we map, we decided to start with FPAI.
What happened to Right to Information?
The FPAI centre in Kolkata is located in Etally. The nearest bus stop is located at 5 minutes walking distance. The centre is located on the inside of a market road. It is a rather old building with a board outside that says Family Planning Association of India and lists all the services provided at the centre. It was hard to miss the strong smell of urine on entering the building premises. It wasn’t the cleanest of centres that we have been to so far, in the country. The first floor has the ward and the office is on the second floor.
On requesting for information about the services provided at the centre, the categorical response given by the medical officer was “Go to the Kolkata headquarters for any information about the services provided here. We will not give you any information.” The staff seemed clearly quite unapproachable. It was quite strange considering that the list of services provided at the centre is listed on the name board displayed outside on the door.
With FPAI off the list, it became important to look into other sexual and reproductive health service centres in the city that were approachable and also provided different services at a reasonable cost. More importantly, were there any reasonable government hospitals in the city providing SRH services?
How good are the government hospitals?
In an attempt to find some answer to that question, SSKM hospital, (located about half kilometer from Rabindra Sadan metro station) was chosen as the next destination. This is a referral hospital along with a medical college attached to it. Reason enough, the hospital is quite large and also usually crowded throughout the day. Located in the centre of the hospital campus, the gynecology department is difficult to locate without any support from the hospital staff. The guard at the gate was quite helpful giving directions to the gynaecology department. Gynecology department is located opposite to the Eye department and diagonally opposite to the Ronald Ross block. However, even with help, it was hard to locate considering the constant crowd on the hospital campus. It is a large department that has a separate building for the neonatal services provided at the hospital.
The cost of acquiring an OPD card in the hospital for all departments is Rs. 2. On checking the OPD registration desk on the ground floor of the building for services provided by the gynecology department and cost involved, we were told to check directly with the gynecology OPD. The administrative staff did not seem approachable. That said, the OPD registration had a constant queue throughout the day. The gynaecology OPD is a clean ward with air conditioning. On requesting from a doctor on duty (an intern), we were asked to talk to the Head of the Department (HOD) of Gynaecology whose office is in the Ronald Ross block. Though Ronald Ross block sounded easy enough, locating the HOD’s office in the building was not easy. The staff and interns that we spoke to, on the ground floor of the building either refused to give any information or said that they are not aware of the office. Being utterly confused in the large hospital, we had to check with several departments including Eye and ENT to be doubly sure of the HOD’s office. Due to sheer exhaustion of locating the different departments and heavy rains, we decided to meet the HOD on day 2.
Eventually on day 2, the HOD’s office was located on the second floor of Ronald Ross building. On landing up at the HOD – Dr. P.S.Chakravorthy’s office, we were asked to come the next day to have a conversation to understand all the sexual and reproductive health services provided in the hospital. Unlike other staff, the HOD was quite approachable and friendly. On day 3, an interview was conducted to understand the different SRH services provided in the hospital. The doctor was willing to answer all questions that were put forth.
Excerpts from the interview conducted:
Sexual and reproductive health services available for men:
“There is a STD clinic in the hospital close to the skin clinic that includes STI and RTI services as well.”
Process of accessing these services:
“The person has to go to the OPD STD clinic and register and see the doctor.”
Most common concerns for men:
“Mostly urethral discharge, burning sensation and gentile ulcers.”
HIV testing centre:
“There is one HIV testing centre that is attached to the blood bank, one to the microbiology lab, one to pathology department and there’s another attached to the antenatal clinc. There may be even more.”
Cost of accessing these services
“Buying the OPD card at Rs. 2 gives access to all services in the hospital including HIV testing centre at no additional cost, for both services and medication.”
AIDs & HIV related services:
“When we find that a person is HIV positive, we send them to the ART centre where they are provided counseling, both the patient and the spouse, medications, lifestyle advices, health education.”
Sexual and reproductive health services available for women
“Same as men and in addition, gynaecology OPD, skin OPD (because of wart). There is an adolescent clinic also – usually for teenage girls related to reproductive problems – menstruation – regular, irregular, pain, discharge etc.”
Medical Termination of Pregnancy (abortion): (Both married and unmarried women)
“We definitely provide abortion services to both married and unmarried women. To us, they are all patients. Irrespective of whether they are rich, poor, no matter the caste or creed, we try to help them.”
Cost of accessing this service
“Even MTP is included in the OPD charges of Rs.2, for MTP involving both medication or surgical intervention.”
“The Plastic Surgery department runs the SRS service. It is again, free. In West Bengal, all services provided by the government are free. This also means that we have a lot of crowd here for all services.”
Other sexual and reproductive health services provided
“Family Planning services and Adolescent Friendly Health Clinics are also available.”
A reality check!
Though the doctor confirmed the availability a wide range of sexual and reproductive services, the concerns raised and expressed by people we spoke to accessing the services included:
- Constant crowd
- Need to have connections inside or outside the hospital to get access to high quality services
- Often junior doctors or interns tend to the patient
On having spoken to the Plastic Surgery Department on the SRS service at the SSKM hospital provided in the hospital, Abhirup Kar, President of Civilian Welfare Foundation said, “The concerned person did not know what SRS was. We had to explain it to them and then We had to explain it to them. We were then told that SRS is not done there and is only a subject of research in the hospital.”
Owing to the concerns raised about government institutions, we thought it necessary to also check with the private institutions on the different SRH services provided. Speaking to Hidden Pockets, a senior gynecologist* with 20+ years of experience said that the price of getting an abortion could range between Rs. 3,500 to Rs.30,000 in any private institution depending on the location. While the cost of getting an abortion could be anywhere between Rs.3,500 to 10,000 in Northern Kolkata, it costs Rs.15,000 to Rs.30,000 in Southern Kolkata depending on the institution and seniority of the doctor.
The senior gynecologist’s (hospital’s) cost breakdown for an abortion was as follows:
Rs. 4,000-5,000 for consultation
Rs.1,000-2,000 for the services
Rs.1,000 or so for medication
Total: Rs. 7,000-9,000 (cost estimated for his hospital’s services)
Note: Hidden Pockets studies focus on recommending at least one SRH service provider in any city that we go out after personal assessment of the centre for different parameters. However in Kolkata, owing to the crowd and unfriendly staff, we could not go beyond 2 government service providers during our time there.
PS: “FPA India clinics may charge, what we prefer to call as a ‘partial user fee’ to the clients for seeking abortion or any other SRH service. This fee is very subsidized and helps the Association meet some running costs. However, all FPA India clinics also have a “NO REFUSAL POLICY”, which states that no client walking into any FPA India facility is denied any service, especially if he/she is unable to afford even the subsidized fee. Thus, poor and marginalized clients can also access quality services in FPAI clinics. Only when the facility is not equipped to provide a particular service (for example some client may need a specialized service, or admission or higher level emergency care) are clients to other facilities.”