On May 5, 2023, 38-year-old Rinzuala,* shared a video link of their first ultrasound showing their unborn twins with close friends and family. At last, he was going to be a father—and of twins. The two-minute video, titled “We are blessed with twins!”, captured his excitement as he squealed with joy when the doctor confirmed they were expecting twins.
However, just four months later, on September 18, 2023—two months before the due date— Rinzuala,* received a frantic call from his wife at around 4 a.m., saying she was in pain. Away on a work trip to another village, he rushed home. The twins were delivered around 7 a.m., 15 minutes apart, at Kawnpui Primary Health Centre. The parents had already chosen names: Lalnunmawia and Zorintluanga.
While Rinzuala,* and his wife had envisioned sleepless nights caring for their newborns, Lalnunmawia and Zorintluanga came home not in their parents’ arms but in two small brown caskets. Instead of soft mattresses awaiting them, they were placed on the cold, hard centre table of the sitting room. Their caskets were draped with a blue floral cloth that matched the curtains in their home.
A System Ill-Prepared
According to the website of the Chief Medical Officer, Kolasib District, the Kawnpui Primary Health Centre, established in 1962, is a ten-bed facility serving a population of 13,285 (as of April 1, 2022) across five villages. It claims to offer 24-hour emergency services. Yet, it was unprepared for this emergency.
The father of the twins told EastMojo that the primary health centre lacked sufficient machinery and equipment, particularly for neonatal care—there wasn’t even an incubator. “The village folk told us it was not possible to have twins here; however, the nurses were very helpful to us,” he said.
Despite a doctor being nearby, when they approached the centre in an emergency, it took over an hour for the doctor to arrive. The father eventually rushed to the doctor’s quarters and met the doctor on the way. The doctor reportedly remarked that while the parents had not consulted them during the pregnancy, they had now come during an emergency and inconvenienced the doctor.
By the time the doctor arrived, the babies had already been delivered by two nurses. “If the doctor had arrived earlier, the situation might have been different,” the father added.
“While it is hard to determine what the best outcome could have been, we believe that the baby who was still alive at birth might have had a chance if the centre had been equipped with better facilities. With experienced medical professionals, we feel our chances would have been even greater,” he said.
Grim Healthcare Statistics
India’s rural healthcare infrastructure continues to struggle. As of March 31, 2023, the Ministry of Health and Family Welfare reported 169,615 sub-centres across rural and urban areas, with 165,639 in rural areas. Community Health Centres (CHCs) total 6,359 nationwide, with 5,491 in rural areas.
CHCs are designed as 30-bedded referral units for four Primary Health Centres (PHCs), while PHCs act as referral units for six sub-centers. PHCs are meant to be staffed by medical officers, and CHCs require specialists, including a surgeon, physician, obstetrician/gynaecologist, and paediatrician.
Mizoram has one of the lowest numbers of medical experts in India. The state, with 871 villages across 11 districts, has 308 sub-centres, 57 primary health centres (PHCs), and nine community health centres (CHCs). However, the healthcare workforce is critically limited. There are only 52 medical officers at PHCs and 11 at CHCs. Alarmingly, CHCs in Mizoram lack specialists entirely, with no surgeons, obstetricians, gynaecologists, physicians, or paediatricians—falling far short of the government’s guidelines, which mandate that CHCs should have at least four specialists.
Mizoram and Sikkim are the only two Indian states with zero specialists in these key categories at CHCs. However, Sikkim’s healthcare demand is lower due to its smaller population and fewer villages. While Mizoram has 871 villages and nine CHCs, Sikkim has only 482 villages, two CHCs, and 24 PHCs. Mizoram also faces a shortage of doctors, with a shortfall of five medical officers at PHCs. For CHCs, the gap is even starker: all 36 specialist posts remain unfilled.
In terms of infrastructure, 252 of Mizoram’s 308 sub-centres lack regular water supply, and 16 have no electricity. Among the 57 PHCs, 41 operate 24×7, all have labour rooms, and 28 are equipped with operation theatres. However, five PHCs lack electricity, seven lack regular water supply, and only 14 have all-weather motorable roads.
Lalsangliani,* a former resident of Khawrihmin, recounted a harrowing journey to Aizawl in late 2022 when her infant daughter developed severe pneumonia. Knowing the limited facilities at their nearest PHC and CHC, they endured a three-hour trip to Aizawl, during which her daughter cried incessantly.
“It was the longest journey of my life,” Lalsangliani* recalled. “My daughter cried the entire way, and when we finally arrived, we were told we were almost too late. A slight delay might have cost her life.”
Now residing in Sangau, a village in Lawngtlai district in southern Mizoram, Lalsangliani* said the conditions at the Sangau Primary Health Centre (PHC) are relatively better. However, she noted that the facility still faces challenges, including a lack of equipment and services to adequately cater to the locals, as well as issues with cleanliness and maintenance. The Sangau PHC oversees four sub-centres and serves nine villages.
She also highlighted another limitation: regular check-ups are only available from on certain days except for emergency cases, which poses problems for many residents who need medical care outside these days.
To add to the woes of villages, the poor condition of roads in Mizoram has been making headlines. In September 2024, the Mizoram Oil Tanker Driver Association (MOTDA) and the Petroleum Entrepreneurs and Transporters Union of Mizoram announced they would halt operations due to the deteriorating conditions of National Highways 306 and 6, which had become a serious safety hazard. The associations decided to suspend operations until the roads were repaired.
The road conditions have also had a devastating impact on healthcare. In July 2021, a 39-year-old pregnant woman from Lawngtlai, South Mizoram, who had tested positive for COVID-19, faced a tragic fate when the vehicle transporting her broke down twice due to poor road conditions. She did not survive the journey. The Chief Medical Officer of Lawngtlai District explained to EastMojo that the ambulance borrowed from a private hospital broke down just ten kilometres into the journey. A NAS ambulance was then dispatched, which also broke down, forcing them to request an ambulance from Thenzawl Ayush Hospital.
During an interview after the death of the pregnant patient, a doctor posted in Lawngtlai district shared their frustrations with the healthcare system, saying, “In terms of facilities, the government has helped little. Everything is politicized. The government provides basic supplies, and MLAs offer some aid. We live in a system where we never have enough, but we always get just enough to avoid a bad reputation for the government. The system looks good on the outside, but internally, we are always improvising. If there were no donations, we’d be in an even worse condition.”
Systemic Issues and Lack of Specialists
Lalrintluanga*, a resident of West Phaileng Village in Mamit district, shared with EastMojo the issue of overcrowding at their Primary Health Centre (PHC). “There is one doctor at our PHC, but many people come for medical care. The PHC is in urgent need of an upgrade,” he said. “We had heard that the previous government had planned to upgrade the PHC to a Community Health Centre (CHC), but that plan has not been implemented. We are also badly in need of equipment, such as an X-ray machine.” The lone doctor at the PHC is responsible for serving people from fourteen villages within its jurisdiction.
One major challenge Mizoram faces is the shortage of specialists and the reluctance of doctors to work in government-run facilities, particularly in rural areas. Dr. Eric Zomawia, Mission Director of the National Health Mission, explained to EastMojo the lack of specialists in Community Health Centres (CHCs): “We don’t have specialists in the CHCs because there is a shortage even in the hospitals. Hospitals are also struggling with a lack of specialists in various fields, so we have to prioritize district hospitals with the specialists we can find.”
Regarding doctors’ hesitancy to work in rural villages, Dr. Zomawia said, “As more private hospitals emerge, most doctors prefer to join these establishments instead of being posted in rural villages. They’d rather work in private hospitals than serve in government-run facilities in rural districts. Maybe if we had more doctors, this situation would improve.”
On the issue of equipment, he acknowledged that while it is challenging to be fully satisfied, efforts have been made to equip Primary Health Centres (PHCs) with the necessary diagnostic tools, including biochemistry equipment. However, challenges persist, such as the need for an X-ray technician when an X-ray machine is available, which is often hard to find. He also noted that the absence of specialists in certain fields has hindered the availability of ultrasound equipment.
Dr. Zomawia spoke about various upcoming projects, such as the Mizoram Health Systems Strengthening Project, a World Bank-funded Project, and the strengthening of district hospitals, all of which aim to enhance healthcare infrastructure in the state.
Political Fitness and Mismanagement
Another issue highlighted by some citizens is the problem of “political fitness.” A doctor employed by the government, speaking to EastMojo on the condition of anonymity, explained that political connections are often necessary to avoid being transferred to undesirable locations. “Political fitness, or having political links, is a very common occurrence in Mizoram,” the doctor said.
A former resident of Kawrthah village in Mamit district shared an example of this issue. The resident shared how a doctor was recently transferred from the village, but the doctor scheduled to replace him refused to take the post. “We are told that this doctor is the type who finds a connection with every new Health Minister to ensure he doesn’t have to move,” the resident said.
This story has been published as part of the AIPP-EastMojo Fellowship 2024.
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