"I was scared stiff and took injections for a month to prevent an infection," said Manke.

If villagers, who are at the sole mercy of local primary health centres, knew the extent of danger doctors expose them to, they would not be able to sleep at all.

In Maswan, for instance, doctors openly admit to reusing disposable needles.

"We don't have enough needles in the stock. We use a needle only 2-3 times and haven't received any complaints," said Dr P Rathod, med . ical officer at PHC in Maswan. "You live in Mumbai where there are more than 10 chemists within 500 metres of a clinic. Here, it costs people half a day's wages to reach a chemist. Who would travel so far to buy a needle? "

More than one use can be enough to invite lethal infections like HIV or Hepatitis B, some doctors, wishing not to be named, said needles were often reused as many as 10 or 12 times.

"We don't have enough stock of needles and tribals living here are so poor they can't afford new ones," said Dr Mohan Waghmare, medical officer at Kasara. The point is, one simply cannot sterilise a disposable syringe for reuse, even with boiling water. "Sharing needles is extremely dangerous. Besides the possibility of HIV infection, the chances to contract Hepatitis B are greater," said Dr Vijay Satbir Singh, ex-health secretary .

Except Palghar, disposable needles were being reused at all the other 11 health centres.

The state health authorities reacted to this with shock. "It is extremely dangerous and I will look into this immediately There is no reason to . blame inadequate stock; we have given them separate funds to purchase medicines. Only steel needles can be autoclaved. Reuse of disposable needles is not allowed," said Dr Prakash Doke, director general of health services.

Lack of basic medicines

Another persistent problem is the lack of basic medicines and life-saving drugs. The primary health centre in Safale, which covers nearly 35,000 people, lacks basic medicines like tetanus, dog bite injections. Even ORS packets were missing a few days ago. "It is easier for me to say which medicines are available than which are not," said medical officer Kishore Gulale, pointing out to the stock register that showed only three ampoules of snakebite injection remaining. On an average day at least three patients vis , it the centre with snakebite.

Dr Basavraj Kadalge, medical officer of a health centre in Kolhapur, said in the absence of basic medicines and injections, he often administers harmless vitamin injections to patients.

"The local people, especially panchayat members, believe injections were the only cure. If I don't give them the vitamin shots, I will risk public wrath and a violent backlash," he said.

Three months ago in Kasara the local medical officer was attacked with sickles for not promptly administering an injection to a patient. Bio-medical waste While the health authorities have strict guidelines on disposal of bio-medical waste, many centres seem to unaware about the details while some simply did not follow it.

"We had received a circular about digging a pit to bury bio-medical waste but we haven't found the time yet. We throw the waste in the trash can with other rubbish," said medical officer Dr S.S. Gaekwad at Satpati, 75 km from Mumbai.

Told about this, director general of state health services Doke said: "We knew that some centres aren't doing segregation properly but it is shocking that they haven't dug a pit at all. The norms are to dig a pit at least four feet deep to bury bio-medical waste and then to cover it."

He said the Maharashtra Pollution Control Board should look into these irregularities.

Bio-medical waste constitutes left-over body parts, organs, tissues, blood and body fluids, soiled linen, cotton, bandage and plaster casts from infected areas and used needles.

These need to be properly collected, segregat- ed, stored, transported, treated and disposed safely to prevent hospital-acquired infection. Bio- medical waste scattered in and around the pri mary health centres has been inviting flies, in- sects, rodents, cats and dogs, as also the spread of communicable disease like rabies.

Cross prescription

Ayurvedic doctors managed more than 60 per cent of the health centres but incidentally they prescribed only allopathic drugs, as no ayurvedic drugs are available at the centres.

Asked how the state allowed this practice, Doke said: "Most of the medicines they are pre scribing come under some national health scheme, but it is true that many potent ones are not a part of a scheme. Though there should ide ally be an allopathic doctor but since they refuse to work in rural areas, we have to make do with ayurvedic doctors. It's better to have an ayurvedic doctor giving allopathic medicines than having none to prescribe medicine at all."

Charging for injections

In many primary health centres, staffers are al legedly taking money from poor patients to inject drugs which are supplied by the government to be given out free.

"The only money they are allowed to charge is the minimum amount for a case paper, which is Rs 5. But we have received information about doctors taking extra money from patients. The difficulty lies in proving it," replied Doke.

For villagers in Maswan, injections cost Rs 10. "Even for a tetanus injection which the government provides free, they charge Rs 10 per prick," said Natwar Patil, the exsarpanch and a sitting gram panchayat member. However, the medical officer denied it. "We only charge Rs 5 for case paper," said Dr A. Rathod, medical officer on duty In Kelve . Mahim, 70 km from Mumbai, when confronted with the allegation of over charging, medical officer Dr D.D. Kukker had an interesting explanation. "It is a tradition going on for years. Villagers take an offence if our staffers refuse money They give it voluntarily . ," he said.

The missing

For the last two months, medical officer in Shenva Dr A.R. More has been solely handling the primary health centre. "There was an OPD nurse but she hasn't come on duty for two months. There is no other doctor so part-time staffers help me out in batches," said More.

Health authorities say staff crunch is an acute problem. "It is one issue we need to resolve. Many posts are vacant," said Doke.

In many PHC's, facilities like ambulances and invertors have been provided but they are nonoperational. "We have an ambulance but no driver," said Dr Gaekwad from the Satpati centre. He said patients were sent to the rural hospital in Palghar, 16 km away on their own.

, But the primary health centre in Padgha, a two-hour drive from Mumbai, does not need a driver. It does not have an ambulance.

ALONG MUMBAINASHIK HIGHWAY

1)Padgha 2) Washind 3) Khardi 4) Kasara 5) Shenva

ALONG MUMBAIAHMEDABAD HIGHWAY

1)Somata 2)Manor 3)Palghar 4) Maswan 5) Satpati 6) Kelve-Mahim 7) Safale