Kashmir’s district hospitals in urgent need of upgrade

The entire district of Bandipore has no gynaecologist and only one paediatrician,who was appointed only a few days ago. The District Hospital has only one orthopaedic surgeon who manages the lone operation theatre and only one anaesthetic who is a diploma holder and not a specialist. As a result the patients,especially pregnant women,are referred to hospitals in Srinagar.

The infrastructure is almost non existent. “We have hardly any infrastructure. We don’t even have a CT Scan machine or even sterilizers or even a generator to run the operation theatre,” said Chief Medical Officer of Bandipore,Dr Bashir Ahmad Malik. “And then you blame us for referring the patients to Srinagar. What can we do? We have no other option”.

The 100-bed Baramulla District Hospital is no better. Established in 1932,the hospital is one of the oldest in Kashmir but it lacks even basic healthcare facilities. The hospital has no paediatrician and its Blood Bank is dry most of the time. There is only one ENT specialist,one eye-specialist and only one orthopaedic surgeon. In the last 15 days all the paediatric cases had to be referred to Srinagar as the Hospital’s only paediatrician was on leave.

And if that was not enough to severely affect the functioning of the hospital,the acute shortage of the paramedic staff has crippled it. “We have only eight people to run five operation theatres. Three of them have been brought from the field as attaches,” said Medical Superintendent of the hospital,Dr Mohammad Shafi Saraf.

And the hospital doesn’t even have a CT scan machine. “If we get patients with bullet wounds or people injured in road accidents we refer them to Srinagar. Because before operating them you need to conduct a CT scan which we don’t have,” Dr Saraf said. The only endoscope the hospital has is gathering dust because there is no one qualified to operate it. “Patients who require endoscopy have no option but to go to Srinagar,” Dr Saraf said.

So how can the district hospitals be made independent and health care system decentralized? “Just constructing new buildings won’t solve the problem,” Dr Malik said. “We have to equip the hospitals with latest equipment and then employ people to operate these. Besides,we need to add hundreds of doctors,paramedics and nurses to our manpower. Only then can the primary and secondary health care system deliver the goods”.

“If a patient gets satisfactory treatment at the district hospitals why would he go to a hospital in Srinagar? It is as simple as that,” said Dr Saraf. “But for that we have to upgrade these hospitals through infrastructure and manpower. And,of course,better administration”.

What the Health Experts Prescribe for putting the healthcare system back on rails:

District and Sub-district Hospitals:

• Improve working conditions in District and Sub-district hospitals.

• Appoint Deputy Directors in each district for better co-ordination between Medical Superintendents of the hospitals and Chief Medical Officers.

• Upgrade the infrastructure of the hospitals. Install latest medical equipment like CT scan machines,ultrasound machines,X-rays etc.

• Address the problem of shortage of doctors,including specialists,urgently.

• Recruit qualified paramedics,technicians,nurses and other staff.

• Patients should be looked after by qualified nurses and paramedics. At present due to the shortage of qualified staff,nursing orderlies and sweepers doing this job.

• Provide facilities to the district hospitals so that they remain functional 24×7.

• Functional Casualty wards should be set up at all the district hospitals.

• Streamline the functioning of the Out Patient Department’s (OPD’S).

• Provide residential facilities to doctors at the district hospitals so that they remain available 24×7.

• Hospitals should provide only emergency medicines to the patients. The system of providing free medicine in the OPD’s should be scrapped.

• Increase the bed strength of the hospitals.

• Upgrade demographically important sub-district hospitals.

CHCs (Community Health Centres) & PHCs (Primary Health Centres):

• Upgrade the demographically important CHCs in the first phase to sub-district hospitals and provide them with better equipment.

• Upgrade PHCs by providing adequate infrastructure and manpower. Also upgrade the PHCs having a large catchment area to Community Health Centres.

Field Doctors:

• The system of posting doctors in rural areas needs to be streamlined. For example,a B-grade specialist (which is a humiliating term) should be called Junior Consultant and then promoted as Consultant and Senior Consultant. Similarly the nursing orderlies should be named as Ward Boys or Ward Girls.

• Promote Primary Care Physician to First Physician to Medical Officer to Senior Medical Officer with fixed tenure promotion.

• Give incentives like rural service allowances to the doctors.

• Ensure proper CME (Continuous Medical Education) which will help the doctors to refresh and enhance their knowledge and skills.

• Make doctors and paramedics aware of their roles and responsibilities.