With faulty infrastructure available, overburdened doctors don’t stick to their ethical code of conduct. While many risk their lives to fight the deadly Virus, people in Kashmir ask how long can we afford the negligence of “messiahs and saviors”. Mukhtar Dar traveled around to find answers to some pressing questions concerning our public health system.
COVID Pandemic exposed Kashmir’s ailing healthcare and caught it unawares. Understaffed and ill-equipped hospitals are ‘war-zones’. COVID 19 is just a test dose. It is believed that as the Corona crisis passes, we will see a huge investment in the health sector. With the corona crisis emerging as the latest challenge to health and well being in society, the administration in JK geared up and attempted to put in every effort to curb the menace. Despite appreciable efforts, it failed for want of sound healthcare infrastructure which drew the focus of the administration and media in the light of things. In a landlocked valley, we have less than a hundred ventilators for eight million people. Needless to mention that the facts as they stand, are positively alarming.
In a region where health care facilities are already not up to the mark, economically vulnerable families bear the brunt of the competition for the limited health care resources in the wake of such a crisis as the Corona pandemic. The government ideally launches several schemes to minimize the disparity in health care facilities on paper but poor planning and unnecessary political deadlock, bureaucratic processes and misplaced priorities hinder the process to provide equal and quality health care facilities to all. However, keeping in view the health indicators, the erstwhile State has performed relatively well in providing medical facilities to the people. Having said that, it is important to note that there is much that is yet to be done at the grassroots level.
A Brief Overview of the status of the present J&K public health system
J&K, the newly created Union Territory has made a considerable improvement to bring down the infant mortality rate (IMR) from 34 to 26 in 2018, which was highest among other states of India; it was 52 in 2006. The total fertility rate (TFR) has dipped from 1.7 to 1.6 in 2016-17. Despite the positive indicators though, it is important to note that the healthcare sector in J&K is far from the Indian Public Health Standards (IPHS) as it lacks manpower and sound infrastructure. The major loopholes in the healthcare system in Kashmir were sighted when it geared to fight COVID-19.
Our existing healthcare sector was never prepared for this medical emergency. The shortage of ventilators, skilled professionals, high dependency units, and protection gears were prime concerns. The LG administration received massive criticism for this deficit in the health sector. As the COVID graph rises with each passing day, it is not yet clear when and how the curve can be flattened. More than 1500 positive cases and around twenty deaths so far is a worrying sign.
Our frontline “exhausted” medicos are doing a commendable job despite limited sources available to them. But amid this pandemic, some grey areas cannot be ignored. It has recently come to the limelight that some doctors are ignoring patients who visit hospitals for TB, dialysis, stomach infections, and other infections. Even the cases of pregnant ladies are not counted in when the imperative of providing urgent medical attention is considered. When two pregnant ladies died due to alleged doctor’s negligence in Anantnag recently, it created quite an uproar. Denying basic medical facilities and procedures for treatment is tantamount to murder. It is reported that SOPs are not followed properly during the time of crisis management. The basic healthcare system is disrupted and left unattended to. OPDs remain closed, surgeries are postponed, no basic testing is conducted in laboratories. All this amounts to a larger looming crisis as the COVID crisis passes. Non-COVID patients dying for want of doctor’s attention speaks volumes about the sorry state of affairs of our ailing healthcare system which is stretched thin today due to inadequate investment in infrastructure and skilled workforce generation over the years.
It was also reported recently that doctors have shouted at and ignored patients outrightly. They are barely diagnosed properly and are treated based on assumptions based on suspected conditions. The ordeal of the Anantnag families losing pregnant ladies raises eyebrows on the Hippocratic Oath doctors to take on the day that they join this noble profession. They are supposed to be prime warriors in this pandemic. These tragic incidents indicate that along with the health care sector we need to upgrade our cognition of priorities and our sense of empathy as well.
A paucity of gynecologists in rural hospitals of Kashmir increases the influx of pregnant women to the city’s single maternity hospital. Lal Ded Hospital is the most crowded place where the mess gets messier. Referrals from district headquarters’ are overcharged and left to wait in terms of being deemed less of a priority for the required attention. Last year, A woman from Kupwara who was from a Gujjar community was called names and was not allowed to sit in the hospital premises. Caste-based discrimination in the medical field is beyond unethical. It is unforgivable. Every human being counts and has the right to medical attention in this country as an equal.
The fact that J&K has only 44 gynecologists in 60 institutions, itself says how prepared we are. RTI filed some time ago revealed that LD hospital received 8241 patients in 2016 from different hospitals of the valley. The data considerably increased to 10,074 in 2017. Mostly, they have to travel long distances on dilapidated roads to reach Srinagar maternity hospital for any emergency or checkup. In Kashmir, the restriction is a common phenomenon. In such circumstances when transport remains invisible, the villagers, particularly women, suffer immensely to reach the medical facilities.
As of 2018, the number of Public Health Centre’s (PHC), Community Health Centre’s (CHC), and sub-centers in Jammu and Kashmir are 3688 that accounts for 1.94% of India’s government health centers. The country’s total number of hospitals is estimated at 1,89,784 in 2018. To have a sound health care system, J&K requires skilled professionals and the need to advocate for basic infrastructure and investment in the private sector. As per the World Health Organization (WHO) standards, the doctor-patient ratio should be 1:500. It means one doctor should be catering to 500 hundred people. But in our part of the world, the ratio is 1:3000; lowest in the country where it stands at 1:2000. There is also the dearth of paramedical staff which is a glaring issue in the valley.
According to the 2011 census, 72.38% people in J&K live in rural areas. But both public and private health care facilities are mostly rooted in urban areas. According to the National Health Profile, The number of government hospitals in the rural areas of Jammu and Kashmir in 2018 was just 35. The beds available in these hospitals were 1221. In urban areas of J&K, the total number of government hospitals was 108 with 6070 beds available. The rural healthcare in Kashmir is characterized by under-staffed facilities with non-existent infrastructure and non-availability of medicines. Pertinently, the public healthcare system in rural areas is a three-tier structure under the National Health Mission (NHM). It was launched in 2005, which comprises Public Health centers, Sub centers, and Community Health centers. They are the main institutions responsible for maintaining health requirements in rural areas. Unfortunately, most of these institutions are dysfunctional with inadequate facilities, less workforce, and ill-equipped infrastructure. Besides this, these health institutions were distributed without any feasibility plan. Mostly, they were sanctioned by legislators to increase their vote bank.
The LG administration should take it as a wake-up call to prepare for future challenges that the healthcare sector is facing in J&K. At the global and national level, the investment in the healthcare sector and medical tourism has exponentially increased in the past few decades to expand on tapping the healthcare market. Where the nation is thinking ahead to bolster its medical tourism image, it is only commensurate that one of the most strategic focus regions of the government( Jammu and Kashmir) should also get due attention in this regard with respect to at least a robust public health care system for the locals.
When the government will provide adequate healthcare facilities, people will pin hopes on the governance system. There can after all be no “good governance” without taking into account the basics for a dignified standard of life guaranteed to the citizens who are looking to the rule of law for their rights and entitlements. It is thus high time to upgrade and update peripheral hospitals for the larger good of the public health system. The focus should be on technology, well trained and skilled health professionals and modern laboratories that can diagnose cases in bulk and at a sustained pace in terms of priority. Besides, in rural health institutions, intensive care beds, trained staff digital laboratories, 24 hours emergency health care unit in PHC and CHC must also be made available at the earliest.