Kashmir hospitals: ‘It’s glucose for all’

According to the data of the Union Health Ministry, Jammu and Kashmir has 2,812 hospitals but what about the dearth of technology and expertise?

Srinagar: Mohammad Qasim (name changed), an elderly man was sitting and sipping tea, casually playing with his grandson. Suddenly crushing pain starts in his chest and arms. Unable to breathe, he is completely paralysed by the pain.

His family members rush him to the nearest hospital, the district hospital of South Kashmir’s Anantnag district.

The doctors there provide him with a drip of glucose.

“No matter what the diagnosis is, all the patients who come here are given a drip of glucose,” says his son.

It was only after the intervention of the family members of the patient who had personal contacts in the hospital, he was referred to Sher-e-Kashmir Institute of Medical Sciences (SKIMS), Soura for treatment.

He had suffered a massive heart attack and was kept in the ICU for four days and a pacemaker was implanted in his chest. This took place in June this year.

In early April this year, Asifa Khurshid (name changed), a middle aged woman had a constant, chronic pain in her head for several days in a row.

She went to the district hospital, where she was also given a glucose drip and treated for intestinal infection.  For four harrowing days she was admitted in the hospital and given antibiotics for her intestinal infection.

After her condition worsened she was shifted to the SKIMS. She was diagnosed with a severe migraine attack.  This is the condition of the district hospital, Anantnag where people from faraway places come for treatment.

“People from far flung areas are compelled to travel large distances in order to get basic medical care. And they are not even treated properly. Diseases are misdiagnosed, senior doctors are not present in the hospitals during nights, glucose drip is given for every possible sickness ranging from heart attacks to headaches. Scores of precious lives are lost every year in rural areas due to this. Pregnant women from far-flung areas remain largely neglected during their crucial pre and post delivery time,” says Mohammad Ashraf (name changed), relative of a patient admitted in the hospital.

The district hospital of Anantnag has a huge rush of patients, as patients from Kulgam and Shopian also come here when they are in need of serious medical attention. But in absence of proper facilities patients are referred to city hospitals. This causes a delay in their treatment which can be fatal.
According to those working in the hospital, the facility suffers from severe shortage of staff and infrastructure. Doctors are not present during nights. The treatment of patients is done either by interns or conveyed by the doctors over the phone.

When contacted, CMO District Hospital, Anantnag Dr Abdul Majeed Mehrab denied the unavailability of doctors. He said that senior doctors are available 24*7, even during nights.

“We can only provide secondary level care in this hospital, for tertiary level care like if a patient needs ventilator support then he needs to go to Srinagar. Some things can’t be treated in the district hospital Anantnag like brain surgery, cardio surgery, for that we need to send them to tertiary care hospital,” he said.

He maintained that they have an efficient ambulance service. “We have a control room, we contact traffic police, we tell them that we are sending a patient and to keep the way clear for the patient. We send critical patients in a critical care ambulance with staff.”

When asked about the complaints from the patients he maintained that proper care is given to the patients, and whatever is available we provide it to them.

“Every day we have 1000 new patients and 1000 follow up patients,” he added.

People who can afford private care, always opt for the private health care. They don’t trust the diagnosis in these hospitals, especially in cases of life threatening diseases. Due to lack of proper infrastructure and expertise of the doctors, patients are compelled to seek help from outside the state.

But what about the people who cannot afford private health care and who can’t afford to travel outside the state for treatment?
Despite repeated claims of the government to strengthen health sector in the state, majority of the primary health centres in rural areas of the Kashmir Valley are in horrific conditions. Most of the primary health centres in rural areas lack qualified medical and paramedical staff, equipment, beds, labs and blood banks.

Tertiary care hospitals are forced to play the role of primary health care and take care of minor surgeries. Patients from rural areas have to come to the city for treatment, even for minor ailments. This is a lot of pressure on the tertiary hospitals which are basically meant for advance care.

According to the data of the Union Health Ministry, Jammu and Kashmir has the second highest number of hospitals in India, second only to Rajasthan.

Rajasthan has 3145 hospitals while as Jammu and Kashmir has 2,812 hospitals. Despite the construction of hospitals across the state, there is a dearth of medical technologies and medical expertise. The doctor patient ratio in J&K is very low with one doctor catering to more than 2000 patients as against the recommendations of World Health Organization (WHO) of 1:1000, which is grossly insufficient.

One patient registered in the department of orthodontics, in the dental hospital, Srinagar for comprehensive orthodontic treatment in September 2015, hasn’t yet received the dental braces. It has been two years.When they inquired about it from the Head of Department and Personal Assistant of the Principal, they stated that they are not authorised to give away dental braces. They said that the government has taken away this authority from the hospital and that they are helpless. The cost of comprehensive orthodontics treatment from private clinics is more than Rs. 30,000.

Dr Tariq Qureshi, an ophthalmologist from SKIMS says that on a daily basis almost 80% of the patients they treat are from rural areas.

“Among the patients from rural areas, at least 60% of them come for fairly serious diseases. Patients are rarely advised to go outside the state for treatment. Earlier people had to go out for cornea transplant but now that is being done here.’

Mental Health Scenario

According to the Kashmir Mental Health Survey 2015, 1.8 million (45%) adults in the Kashmir Valley show striking symptoms of mental distress.

Approximately 1.6 million adults (41%) are living with significant symptoms of depression, with 4,15,000 (10%) meeting the diagnostic criteria for severe depression.

A majority – 93 percent – have experienced conflict-related trauma. An average adult was found to have witnessed around eight traumatic events during his or her lifetime. More than 70 percent of adults have experienced or witnessed the sudden or violent death of someone they knew.

This report was the third of its kind on mental health carried out by MSF. Its first two were in Iraq and Syria.

The Government Psychiatric Diseases Hospital Srinagar is the only hospital for mental health in all of Kashmir. It is now known as Institute of Mental Health and Neuroscience. Most of the patients that come for treatment suffer from depression. And there are more males than females in the ratio 2:1.

“Most of the people we treat are from the rural areas. During curfews and strikes they face problems in reaching the hospital, but there is a free supply of medicines for one month from the hospital. That helps us to tackle the problem when the situation is not normal, “said Dr Mohammad Maqbool Dar from the Government Psychiatry Diseases Hospital.

There are two psychiatric centres in the valley, one is Psychiatric Diseases Hospital in Rainawari, Kathidarwaza, which is a 100 bed hospital and another one is in the GMC premises, Shri Maharaja Hari Singh Hospital or SMHS Hospital which is a 30 bed hospital.
According to Dr Mohammad Maqbool Dar drug addiction patients are mostly admitted in SMHS. There are separate male and female wards. And in Kathi Darwaza, psychiatric patients and addiction patients with psychiatric problems are admitted. After these patients are calmed down, they are shifted to SMHS Hospital.

“We provide medication, counselling as well as psychotherapy. We have psychiatrists and psychologists. We have 5 clinical psychologists. We also have a couple of counsellors and a social worker,” says Dr Dar.

On an average there are around 100 patients in Psychiatry Hospital, Rainawari and around 100 in SMHS per day. Although the Psychiatric Hospital, Srinagar is considered as a centre of excellence, but there is a dearth of man power.

“We are building a new compound in Kathi Darwaza, which is 70% complete. The only issue is man power. When the PG was first started here, there used to be two MD psychiatrists. Jammu psychiatrists are the products of GMC, Srinagar. After few years the seats were increased to three. This year we have further increased it to five psychiatrists each year,” Dar informed.

He further added, “Some go to Jammu, some stay in Kashmir and some also go outside the state. These psychiatrists go to district hospitals. We have psychiatrists in the Pulwama, Budgam and Sopore District Hospitals. We have four seats for MPhil clinical psychology. Presently we have three students for clinical psychology. They will complete in 2 years.”

This number is of grave concern in the valley where nearly 1 in 5 adults is living with significant PTSD symptoms.
In 1989, the year the armed conflict started, around 1,700 people visited Kashmir’s only psychiatric hospital where as in 2012 the number had increased to more than 100,000 highlighting the need to establish effective mental health services in the valley.

There are numerous reasons for the huge decrease in mental health, but conflict in the valley has played a huge role. According to Dr Dar, this number is less but still to some extent it is better than other states. There is no MD psychiatry in Jammu.

“Our scenario is better than other states but there is a dearth of man power. Right now we are 4 permanent consultants, we have to go to two places, turn wise, Rainawari and SMHS,” he added.

As the conflict keeps on adding to the physical and mental injuries, the state, especially the valley needs medical attention, both structurally as well as in expertise.

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