With all focus on pandemic, non-Covid patients too need some attention
Since most of the main hospitals across Kashmir have been designated as Covid dedicated hospitals and the main tertiary care facility centers have also closed down their OPDs and non-emergency services in the wake of Covid-19 spike; the non-Covid patients are rendered suffering for their treatment.
Barely a week after Shri Maharaja Hari Singh (SMHS) hospital, one of the biggest multi-specialty hospitals in the Valley, in view of the rise in the Covid cases, decided to close its outpatient department (OPD) and designated its 12 affiliated wards for treating the infected patients only; authorities, on April 24, designated as many as 23 hospitals (8 in Jammu & 15 in the Valley) for treatment of Covid-19 patients.
A few days later, on May 10, SKIMS, Kashmir’s leading tertiary care facility also announced closures of its OPD; where, according to the sources, on an average 1800 patients used to visit daily for their treatment.
Where would we go? Non-Covid patients have been asking since the doors of the tertiary care facilities and all other main hospitals have been closed for them.
Officials claim that these non-Covid patients are being taken care of through tele-consultations and also in emergency departments if needed. However, some patients and doctors while sharing their experience about the tele-consultations told this newspaper that this service is almost useless and it can never be a substitute for in-person doctor-patient consultation.
Thousands of patients, many of them with serious ailments such as cancer, heart ailments and kidney disease or those who are grappling with diabetes and high blood pressure, allergies, asthma, and so on, used to visit the Outpatient department of the main hospitals across Kashmir daily. In every hospital, one would see the patients in long queues for specialized consultations in general medicine, neurosurgery, cardiology, endocrinology, neonatology, and other departments. However, now these thousands of patients are rendered helpless for routine checkups, and treatments. Even the patients, other than the Covid infected, are unable to get their medical tests and investigations done in these hospitals now. The situation is causing deep distress among these non-Covid patients.
Earlier, the patients with chronic kidney diseases, heart ailments, or those who are battling with cancer and other serious diseases would normally visit OPDs for checkups at least twice a month, and while visiting the OPDs, these patients would also get their tests done here to be updated about the status of their ailments. Even the new cases involving various ailments such as cancer, heart and kidney diseases in the patients used to be detected as the result of investigation done in the OPDs. However, such patients don’t have any access to this facility. Even due surgeries (Of course non-emergency) have been postponed in the hospital.
Since government has barred the doctors from talking to the media persons, they refuse to share their opinion against the closure of OPDs on-record. However, several doctors on the condition of anonymity informed this newspaper that closing down OPDs is proving fatal for some patients.
On the other hand, health department officials say that in view of the spike in covid cases, it was imperative to close down the OPDs and non-emergency services in order to divert all the resources to fight against the pandemic. They say keeping OPDs running would have further enhanced the spread of the pandemic because maintaining social distancing in the OPDs was not possible. They also say that tackling Covid has become a priority in the given situation and in view of the overflowing of Covid patients hospitals needed to keep more space vacant and more staff available for treating these patients.
Is it advisable to ask non-Covid patients to hold their fire until the pandemic goes away? How useful are the tele-consultations, and can they be an alternative to face-to-face doctor-patient consultations? Was closing down OPDs in main hospitals the only method available to ensure Covid patients do get focused treatment in the hospitals? How long can we afford to keep OPDs closed down? To know the answer to all these important questions, KASHMIR IMAGES spoke with several concerned officials and doctors.
Here are the excerpts:
I would be lying if I say that people do not face problems because of the closure of the OPDs but, in the medical field, there is something called “triage.” It defines a process of determining priority and degrees of urgency for treating patients in crises. Since the pandemic is a great health crisis, thus triage applies here.
When we talk of fighting against Covid, we are in a war-like situation. At this point in time, our first and foremost priority must be battling with Covid, everything else can wait. The Covid sufferers need medical attention more than anyone else needs. We cannot tell a Covid patient, who is battling for life that he or she cannot be treated because the doctor is busy treating someone’s knee or shoulder pain.
Except for emergencies, all the non-Covid patients can be treated later. For example, if someone is carrying a stone in his or her gallbladder, it is not an emergency. We can send such patients home for some time and instead start treating Covid patients, who may die if not given immediate attention.
Moreover, we have not closed down OPDs at every place. We have closed OPDs only in hospitals where there are Covid centers in place. And for emergencies, there are sufficient arrangements everywhere at place. Similarly, we have kept maternity facilities available everywhere. For example, the district hospital in Pulwama is designated as a Covid hospital, but a nearby private nursing home has been taken over by the health department, where we shifted our maternity department. Our doctors while using the facilities available at the nursing home treat the patients there free of cost. Tele-consultations have also been started across the Valley.
That said, I do not deny that some people might be facing problems. However, we must understand that we are facing an abnormal situation because of the pandemic. We are caught in a war-like situation, where our focus must be to defeat this bloody disease.
In the given situation of the pandemic, closing down OPDs in the hospitals was an intelligent decision taken by the health authorities. First, because continuing to allow hundreds of patients to visit OPDs would have been more fatal because those who are already grappling with various ailments are more vulnerable to the Covid infections. Wouldn’t it be foolish if a patient comes to treat his headache to the hospital and returns with a life-threatening Covid infection? Second, if we have to get rid of this pandemic, we must ensure the chain of infection breaks. For that, no gathering of the people should be allowed at all —whether in mosques, temples, marriage functions or for that matter at OPDs. If the spread of the virus is not contained at this stage, it will go out of control and eventually cause havoc. Thirdly, there was no other option than the closing down of the OPDs. Simply because maintaining social distances at such places is almost impossible.
Also, I think closing OPDs in hospitals such as SMHS and SKIMS might pave the way for implementing a referral system here. We have been seeing that people even with minor health complaints come to these tertiary hospitals causing unnecessary load on these hospitals. Now since they are closed for the time being, people will start availing themselves of medical facilities at nearby health centers in villages and district headquarters.
As far as the tele-consultations are concerned, they are helpful in 90 percent of cases. Since the outbreak of the pandemic, most people worldwide take online consultations. I myself have successfully treated hundreds of patients online since the Covid started to spread last year. Thanks to the technology, patients are able to send their investigation reports and even X-rays to their doctors on WhatsApp. I think this is something we can call a new normal that we have to adopt until this pandemic vanishes.
OPDs were closed with the intention of safeguarding the people. At SMHS, I myself tried to ensure that people who come to the OPD maintain physical distance, but all efforts in this regard were in vain. Rush in the OPD was causing a great threat in terms of virus transmission. As a doctor, I can tell you that we do not have any other option but to keep OPDs continuously closed to stop the spread of the infection and save the lives of the people. Those who oppose the decision of closing down OPDs should come up with suggestions and explain how we can ensure the safety of the people from the virus while allowing them to visit hospitals like they used to be.
Moreover, we should keep in mind that besides tele-consultation links being open, the emergency departments in all hospitals are also working as usual. In case of emergency, people can visit the hospitals at any time. For routine checkups, they can go to nearby primary health centers, and for specialized treatment, they can go to the district hospitals. There may be some problems here and there, but in general health system across the Valley is in place.
At SKIMS, we are doing our level best to treat non-Covid patients. We are successfully running tele-consultation here. We have publicized the phone numbers of the doctors and patients who call them to seek medical advice and get online treatment. Patients who need physical consultation are asked to come to the hospital where we have kept a door of the outpatient department open for them. They get physical examination and investigation done if needed. We ensure that the patients who really need to be seen by the doctors do not suffer. As soon as the situation is suitable in terms of the dip in the ongoing Covid cases, I think the OPD would be thrown open like it was earlier. Till then, we have to manage the situation somehow.
I am not holding any administrative position, but as a public health expert, I would suggest that we have to take care of the disease burden as a whole, and the disease burden does not mean only Covid. Though Covid is a health emergency, it needs extraordinary care.
Severe Covid patients cannot be treated at local health centers or sub-district hospitals. Only district hospitals and large hospitals like GMC hospitals, SKIMS medical college, Chest Disease hospital, JLNM hospital, and so on can deal with severe Covid patients. There is no doubt that Covid patients need to be given top priority as far as the treatment is concerned, however, we have also to take care of the problems of patients who also need immediate care. For example, patients suffering from cancer, kidney diseases, heart ailments, diabetes, and so on and so forth need to get good medical care. This is my opinion and it has nothing to do with government decisions. Government decisions have their own reasons and logic, but I think while treating Covid patients, we should not neglect non-Covid patients. We have also to understand that Covid is going to be with us for quite a long time, so we cannot neglect patients other than the Covid infected in the name of treating Covid patients. Every life matters.
Even in the first wave of the pandemic, we saw more non-Covid patients dying than the Covid patients. Many of these non-Covid patients died due to the lack of treatment as they did not come out of their homes for treatment due to the fear of getting infected.
Patients are not afraid of coming out for treatment, but they are simply refused to be treated at hospitals. This is unjust and cannot be acceptable. I have been crying since the outbreak of this pandemic that we require to treat every patient whether Covid or non-Covid with the same zeal.
Pandemic infected patients indeed should be treated on an emergency basis, however, simultaneously, we need to ensure that other departments of the healthcare system are not disrupted. How can we ignore the fact that we have more non-Covid patients than Covid patients? These non-Covid patients have to be treated as they used to be earlier.
Most importantly, let me say that the tele-consultations do not work at all. Treating patients on telephones might even land some of them in complicacies. For example, if an elderly person with a complaint of weakness contacts a doctor on phone. The doctor might suggest some tonic to the patient. But the actual cause of the weakness might be the patient’s underlying pneumonia. Since in the physical absence of the patient the doctor will not be able to diagnose the real cause of the weakness and eventually his or her inability to treat the hidden disease may cause even death to the patient. Similarly, if a pregnant woman feeling unwell would telephonically contact a doctor to try to get advice, how could a doctor be able to know whether the baby inside the womb of the woman is alive or dead? To add one more example I would say that there are some alarming symptoms of a heart attack that most people are unaware of. Sometimes people wrongly guess these symptoms as of indigestion. Only a doctor can diagnose these symptoms properly only when a patient is brought to him or her. Such patients cannot be diagnosed or treated on phones. I am sighting these examples to make you understand that the medical field is not education, which you can provide online to the students. In the online education system, even if a student does not understand what is being taught, yet he or she has a life ahead to understand it. However, in the case of online consultation, if a doctor fails to understand the problem of the patients or the patient fails to make the doctor understand his or her symptoms, it may prove fatal for the patient.
That is why I say these tele-consultations are nonsensical and thus do not work beyond a certain limit. I have also kept a helpline open to manage Covid apprehension of the people. However, that does not mean I treat patients through this helpline. That is not possible rather it could prove fatal.
Patients need physical consultation of doctors regularly to ensure their underlying diseases do not go out of control. For instance, the blood sugar level of a patient, if not monitored regularly, may shoot up at any time and eventually could cause the death of the person. Hypertension, similarly, if not treated with pace can cause stroke or heart attack. A patient with diabetes can go into a coma or can have a stroke if his treatment is ignored for some time. Even a slight shoot-up in blood sugar can land a patient into complications. Similarly, if the gallbladder of a person gets infected and is not treated by a minor surgery on time, it can cause complications or even death of the patient. People grappling with such ailments need to be seen regularly by the doctors and that too with in-person consultations.
Even patients with chronic diseases need to be treated on a regular basis. For example, a delay in the treatment of a cancer patient could prove fatal for him or her. Cancer may spread in the body of the patient if he or she is not under a doctor’s constant watch.
As far as the pandemic hit patients are concerned, nobody can deny the fact that they need to be effectively deal with. But at the same time, we need to take care of non-Covid patients while keeping the standard system intact.
Any patient, whether Covid or non-Covid, coming to the hospital should be received by the concerned department and treated well; and any patient with severe Covid symptoms or with abdominal pain, coming to the hospital running, is an emergency case and should be treated accordingly. Both can die if not treated timely.