The four posts for chest physicians in the hospital are vacant. Ex-medical superintendent J.N. Banavaliker, who retired a year ago, was the last chest physician on the hospital's rolls. The present MS, The hospital has not had a thoracic surgeon for over a decade. It does, however, have a general surgeon, P.K. Das. Dr R.N. Bansal, a general surgeon who left last month, says he had refused to perform thoracic surgeries because he was not qualified.

Hospital head Patnaik says that three of the doctors are MDs in chest and TB diseases and though they have not gone through any UPSC tests for the post of chest physician, they are as good as any.

On the lack of surgeons, Patnaik says he is not the recruiting authority and is helpless. Besides doctors are drawn towards cardiac surgery rather than thoracic surgery as TB is a poor man's disease, he added. The operation theatre, Patnaik says, is being used for minor operations like rib dissection, biopsies and broncoscopies. Besides, drugs are more effective now and hardly 10 per cent of patients need surgery, he says. Which also means that when surgeries are needed, the hospital makes do without them.

In the Centre-run TB hospital at Mehrauli which has only 600 beds as opposed to the 1,200 beds in RBTB, 15 to 20 thoracic surgeries are performed every month, according to anaesthetist Dr Ashwini Kumar. The thoracic surgeries alone add up to 10 each month, he says. The conditions that require surgery are mostly advanced stages of TB when a part of the diseased lung is to be removed or when the pleural wall thickens or there is coughing of blood.

RBTB doctors say patients in advanced stages are terminal cases and nothing can save them. As for the lack of chest physicians, a senior chest physician in the city says: ``A speciality hospital hinges on specialists. There is a total lack of expertise in RBTB which is criminal. Ninety per cent of patients referred by various hospitals are turned away and the rest are guinea pigs in the hands of novices.''

Nevertheless, the hospital is the last resort for many who have no hope. ``We have been doing our best. Patients should not lose faith in us,'' Patnaik says.