The government resolution (GR) on the role of dietitians in state-run hospitals clearly mentions that dietician patient ratio should be 1:50 (one dietitian for 50-bedded hospital), however, the guidelines are based on the situation in the seventies. With a constant rise in the number of patients, especially in JJ group of hospitals, it is becoming impossible to manage the patients’ diet given that there is a skewed ratio.

“According to the GR that was framed in 1976, there has to be one dietitian for every 50-bedded hospital. Till date there is only one dietitian in the hospital, but what has increased is the number of patients. And in current scenario, one dietitian is looking after 600 or 700 odd patients admitted in the hospital, and at JJ hospital the situation is even worse with 1,300 patients admitted at any given point of time,” said Sangeeta Patki, secretary, Maharashtra Dietary Association.

“We had recently increased the number of dietitians by one in Bhandara hospital. However, the post was later abolished by the state for an unknown reason,” said a source in the bureau of nutrition. The bureau is incharge of the nutritional status of the state.

Also, the recipes have not been changed and there is no provision of diet for lifestyle and chronic disease patients. “Diet is deficient in state hospitals. Especially for patients with coronary heart disease, coronary vascular disease, and for patients with hypertension, diabetes and renal failure (kidney failure) there is no separate dietary provision,” said Shobha Agarwal, dietitian from St George hospital, Mumbai. “In a city like Mumbai where there is a sharp contrast in the type of cases we get right from obesity to malnutrition, not all can be put on the same diet regime,” Shobha added.

The old GR, according to Agarwal, only mentions the amount of nutrients to be given to women patients, male and children patients but does not specifically mention for what disease.

Matters are even worse when it comes to hospitals outside Mumbai where dietitians double up as stewards and administrators apart from supervising the kitchen. “We don’t have liberty to create our own recipes because of the limited number of ingredients prescribed in the GR, like for example it is necessary to give liquid diet — anything clear and semi liquid — before and after surgery (liquid surgical diet). However, all we are given to work with is milk and sugar. As per the specifications from the state we have to give patients 1.5 litres of milk a day. Forget about fruit juices and soups, we cannot even make custard out of the milk,” said Nahid Deshpande, dietician from Jalgaon.

Early this month, 55 dietitians from across the state working in district hospitals visited Mumbai for a three-day workshop at Cama and Albless hospital to advance their knowledge about dietary management of patients admitted with various diseases in the hospitals. Many of them admitted that modernization has not touched their field of work.

The association, recently formed, has put forth their demands in front of the director of health services Maharashtra Dr Prakesh Doke. However, Dr Doke has just assured them that the state will look into the matter, “They have given us their demands for hike in payment and also acknowledgment of their role as dietitians. We will look into the matter,” said Dr Doke.

“There is no scope for promotion, once we are absorbed in the hospital as dieticians, we remain one till the time we retire,” added Deshpande.

“Last year in August, the bureau of nutrition had modified the GR to introduce diet for lifestyle diseases, but it is not yet implemented. The dietitians are allowed to modify the prescribed diet but only with the existing quantity of ingredients mentioned in the GR issued in 1976,” added the source.