Kashmir’s Mismanaged Healthcare!

(Even though we have some of the best doctors and reasonably good infrastructure, yet the general healthcare remains below reasonably good standards due to administrative mismanagement!)

Recently on the basis of an unverified sting operation conducted by a “notorious” TV channel which has been depicting Kashmiris as anti-national criminals and rogues, the government removed the head of the premier health institution of Kashmir and some other consultants. Allegedly, some other motives than improvement in the healthcare are attributed to this unprecedentedly fast step. The State Government even disregarded the directions of the Honourable High Court in this regard. One would not like to comment on the veracity of the episode before the findings of any inquiry gives its report on the subject. Even if all the allegations levelled are presumed to be true, the episode only represents the proverbial tip of an iceberg as regards the state of healthcare in Kashmir which suffers from acute mismanagement and neglect. If the rulers think they can improve the working of the institution by merely changing its head, they are mistaken. What is lacking in all such institutions is the absence of a hospital administrator. Hospital Administration is a specialized subject and every consultant, howsoever, excellent he may be in his specialized line, cannot administer a specialized institution. Incidentally, the first head of the institution was a real specialist in Hospital Administration. An instance of mal-administration is running the Institute like an office. During night no consultants or specialists are available. In fact, there is urgent need for consultants to be on call and even some can stay within the premises for which accommodation and food can be provided by the hospital. Similarly, casualty is the face of a hospital. Again it looks like a fish market being attended by junior doctors. It needs to have senior doctors from each specialty.

No one doubts the capability and professional experience of Kashmiri doctors all over the world. In fact some of the doctors have made a name in different fields of medicine and surgery. One of the most renowned gastroenterologists is known all over the world for his discovery of a certain type of hepatitis. One of the top most cardiologists known all over the world is a Kashmiri. There are numerous other doctors in various fields of medicine and surgery who are held in high esteem in different foreign countries. In Kashmir itself we have had many capable doctors. Dr. Ali Mohammad Jan had become a legend during his life time and was probably the best physician in this part of the world. Even at present there are so many doctors whose reputation goes much beyond the borders of the state.

As regards infrastructure, well, we can safely say that we are not lacking as compared to other states or even to the top level facilities available in Delhi and other metros. However, the main problem is mismanagement of the infrastructure and the personnel involved in healthcare. Firstly, the premier institutions and some of the major hospitals in Srinagar are forced to handle the entire load of the Valley. This is because of lack of good primary health care throughout the valley. If the primary health care in rural areas and districts is up to the mark, there will be very much less load on Srinagar hospitals. Incidentally, Government has made it mandatory for freshers to serve in rural areas. In fact, it seems like a punishment! The need is for freshers to work with senior doctors for at least 3 to 5 years to gain experience. Senior doctors with experience should give some time in district hospitals and rural areas. They can filter many cases leaving lesser load on major hospitals. An endocrinologist and a neurologist in peripheral hospitals would be a great help. Only specialized cases need to be referred here. At present every one even with minor problems lands in Srinagar. The super specialty Institute has virtually turned into a General Hospital. The outpatient departments there are virtually like a Fish Market!  One of the reasons for that is lack of sufficient counters to get a ticket. Normally, these counters should have been outside the hospital and the number of counters could be increased for each specialty. Moreover, there could be two shifts of outpatient care. The doctors in wards and the OPD could rotate during the day.

There are district and sub-district hospitals in all parts of the valley. Some of these may be quite well equipped but these are supposed to suffer because of the absence of specialists and consultants. Similarly, some of the primary health centres have always the problem of doctors not staying there. The absence of specialists from district hospitals is attributed to these being non-teaching hospitals and the service given there by consultants does not count towards their teaching experience needed for promotion in various faculties. This drawback prevents top consultants from going there for a posting. The primary health centres have the problem of accommodation and other facilities for the doctors and other staff posted there. Incidentally, some of the Kashmiri doctors working in Middle Eastern countries have no objection in going to far off places in the desert because the facilities provided there are even better than those in the cities! Both these aspects need to be given top most attention.

Incidentally, there is only one Maternity and one Pediatric hospital in the entire valley to cater for a population of 8 million people. Also Kashmir must be among the very few places in the world where in Maternity and Pediatric hospitals two to three patients are put on a single bed! No doubt the district hospitals take care of various cases and refer only cases needing special treatment to Srinagar institutions. However, people on their own rush to Srinagar hospitals because of well-known consultants. The one possible solution could be to have some smaller Maternity and Pediatric hospitals in various district headquarters. In recent years a number of private “Hospitals” have come up in different parts of Srinagar and some other places. Unfortunately, no one is bothered that these units cannot be called hospitals in the real sense of the word. A hospital should first of all have an emergency and a lifesaving facility such as a fully equipped intensive care unit with ventilators and so on. Most of the private hospitals here are upgraded polyclinics or nursing homes! No one seems to be bothered about this aspect.

While talking of so called malpractices which now include the banned so called private practice by government doctors is only a tip of the iceberg. Firstly, there need not be a ban on the private practice by Government employed doctors if this is done in their own private time. They need not be given any non-practicing allowance but can practice before or after their duty hours. However, on rotation some doctors could remain available even after working hours which should be from 8 am to 6 pm. One cannot go by labour laws as regards healthcare. This is essential to cater for patients all of whom cannot be attended during duty hours. Everybody knows there is a great dearth of doctors especially the specialists.

Apart from private practice, there are many other malpractices. There is supposed to be a nexus between the pharmaceutical companies and doctors on one hand and between diagnostic centres and the doctors on the other. Pharmaceutical companies give many perks to doctors for prescribing particular brands. Apart from household items, they are even offered foreign trips! Most of the diagnostic centres have a liaison with some doctors who ask patients to get their investigations done at some particular centres who reimburse them part of the charges levied on patients for various tests. Sometimes poor patients are asked to go for a number of tests which may not be essential for establishing a diagnosis!

Incidentally, Kashmir is probably the largest consumer of drugs in the whole country. The number of pharmacies is countless. One finds a pharmacy at every nook and corner. Strangely, pharmacists can dispense any drug even without a prescription. Antibiotics and many other scheduled drugs are sold over the counter like sweets from a grocery! Apart from selling all types of drugs just over the counter some of the pharmacists especially in remote areas have been observed writing even prescriptions!

If one goes on enlisting the ills of the healthcare, one may have to write many columns. Thus the recent episode at SKIMS is only the tip of the iceberg. If the government is sincerely and honestly interested in improving the healthcare both at the basic as well as at the specialist level, an overhaul of the entire system is required. The sooner it is done, better it would be for the good health of all!