Visuals of pregnant women taken out on wooden stretchers from the tribal belts of the valley resurfaced on social media this winter. Behind the petrifying picture is the futile and equally fatal healthcare infrastructure of Kashmir’s countryside.
Caressing her baby bump and cherishing her impending motherhood turned dark for Afroza on a cold December night in 2020, when a sudden shooting labour pain ended her sleep.
In a painful state, the 25-year-old realized that it was going to be a long treacherous journey before she would lap and sing a lullaby to her new born.
Some 30 kilometers away from Srinagar, she lived in the hushed hills of Fakir Gujri — where in the past many pregnant women were taken out on cots amid snow and slippery slopes.
Even as the snow was yet to carpet the landscape and make slopes slippery in her native village populated by the Gujjar community, going downhill in darkness was still a daunting task.
But when that midnight pain became unbearable, Afroza’s husband, Manzoor Khatana, rushed to the nearby Primary Health Center (PHC) to avail an emergency health service. But his desperate run ended on a disappointed note.
Absence of an ambulance in health emergency had been long taking toll on his 2000-strong tribe. Mindful of the same apathy, Manzoor had already saved a cab driver’s number in his cellphone.
With trembling fingers that night, he dialled the number. To his luck, it was quickly answered. Sensing the health emergency, the cab driver left his warm-bed in a cold night, and pulled over his vehicle in front of Afroza’s home in no time.
As usual fearing doctor’s absence, Manzoor avoided the PHC and straightaway drove his wife to Kashmir’s only maternity care hospital, Lal Ded — the healthcare centre earlier frequented by the couple for regular check-ups and ultrasonography (USG).
Despite those visits proving to be an uphill task for the gestating mother, she finally delivered her child in a very frantic manner.
Such desperate drives have become an afflicted feature of Kashmir’s trauma-ridden grassroots—provided with ill-equipped PHCs.
A common refrain among Kashmiris remains that these PHCs often lack necessities, like sterilization equipment for infection control, labour rooms, oxygen supply, X-ray and ECG facility, and even emergency drugs.
In January 2021 itself, many patients from far-flung areas bypassed these primary health centres and trekked to the district hospitals for emergency medical assistance.
“The PHC near my home is nothing more than a pharmacy,” said Manzoor, sitting in his snowbound shelter overlooking parts of Srinagar.
“It’s useless to go there for treatment. You cannot find a doctor there except for Tuesdays. For rest of the days, the PHC is run by a basic health worker.”
Three years ago, informed an insider, a USG machine was installed in Fakir Gujri PHC. “It still awaits an operator,” he scoffed.
Such a treatment is only forcing these tribals to travel to district or tertiary care hospitals to undergo a basic test like USG. This unchecked grassroot trickle, medics say, is only overburdening Kashmir’s special healthcare centres.
“PHC at Fakir Gujri is not under my mandate,” Sameer Matto, Director Health Services Kashmir, snapped the query.
When asked about the staff strength in PHCs, Matto said that the number of doctors available with the department has been placed in the peripheries. He hung up soon after facing a query on the infrastructure of the PHCs under his jurisdiction.
PHCs are the first base, acting as referral units for six sub-centers. They flow into community health centers (CHCs), followed by the sub-district and district hospitals, and then medical colleges and tertiary care centers, such as SKIMS and SMHS hospitals in Srinagar.
“On average, primary health facilities had only 51% of physical infrastructure and amenities available,” reveals the 2019 study entitled, ‘Traversing the margins: Access to healthcare by Bakarwals in remote and conflict-prone Himalayan regions of Jammu and Kashmir’.
“Health workforce shortage [in PHC] was found to be the greatest predicament inadvertently increasing the barriers, as 47.8% of human resources were in place indicating a shortage of 52.2% as against the norms. Also, the score encumbering the availability of equipment was found to be unsatisfactory at 44.25%.”
It was also found that there was also a shortage of medicines and consumables owing to the supply-side constraints in the facilities as only 42.2 per cent of the medicines from the essential drug list were available on the date of the survey.
Despite these telling studies exposing the poor rural healthcare system, the authorities are only steering clear of controversies. This ‘thick-skinned’ stature prevails despite this ‘pan-Kashmir’ peripheral health crisis at times becoming a rallying cry.
In fact, before abrogating his wannabe “Imran Khan-Arvind Kejriwal” political-blend image, ex-bureaucrat Shah Faesal during his maiden political rally in his hometown as Jammu & Kashmir People’s Movement poster boy had questioned the lack of health facility in northern pockets of the valley. Much of that anguish had to do with the lives lost in translation.
But while the question is still being asked—“what’s stopping the ‘development’ driven officialdom from making grassroots healthier”—young lives like 20-year-old Akhtar continue to suffer due to the larger indifference.
Hailing from Shopian district’s Zarkar Shalidar village, Akhtar delivered her child on the road after she was carried on a wooden stretcher during a heavy snowfall in January 2021.
As there was no labour room facility available in her village PHC, Akhtar’s husband, Papa Poswal, called his neighbors and tied her on a wooden stretcher. To protect her from the snow, she was covered with blankets.
The villagers carried her on shoulders through ankle-deep snow. But on the way to the district hospital, 5 km away from her home, she delivered her child on a wooden stretcher.
“It was a very awkward situation for me and my husband,” Akhtar recounted her happy-turned-haunted life moment with painful expressions. “I experienced immense humiliation and hardship.”
Like Akhtar, 24-year-old Sufiya was also carried on a wooden stretcher in Lehan Dajan village of Pahalgam to a district hospital at Salar village. Sufiya was expected to deliver child on January 6, 2021.
“It was snowing heavily and there was no transport on roads, nor was any ambulance available,” Zubair recalled his nervous run to PHC.
“I had no option than to call my friends and carry my wife on our shoulders on a wooden stretcher. We trekked for four hours to reach the district hospital.”
These winter health crises created by the poorly-staffed and stocked PHCs aren’t confined to pregnancy cases alone.
Lately, an elderly man was also carried on a wooden stretcher amid snowfall from Zubair’s village for the emergency treatment.
“You can hardly find doctors in these primary health centres,” Zubair continued to depict the grassroot healthcare trauma. “We’ve to travel a long distance to access healthcare.”
But these detours don’t always yield desirable treatment at district hospitals bereft of emergency drugs and other essential diagnostic equipment, said tribal activist, Zahid Parwaz Choudhary.
“That is why,” Choudhary added, “the tertiary care centers are crowded with patients because district-level hospitals don’t cater emergencies.”
In the backdrop of the recent forest eviction drives, these unending health trauma are only making the tribal activists to raise a war cry for the marginal change.
“Despite government assurances, tribal people still struggle to access even basic health facilities,” continued Choudhary, who heads Jammu and Kashmir Gujjar and Bakarwal Youth Welfare Conference.
“PHCs in rural areas do not serve the purpose at all. They’ve just occupied a piece of land. Especially in winter, people have to travel on foot through ankle-deep snow and carry the patient on their shoulders. What could be more shocking than women delivering on roads!”
Notably, after Kashmiris and Dogras, Gujjar and Bakarwal are the third largest ethnic group in Jammu and Kashmir. According to the 2011 census, these tribals constitute 11.9 percent of the population — 1.5 million of 12.5 million people.
Since Bakarwals do not have permanent homes, they migrate to plains in Jammu during winters, and come to Kashmir in summers.
However, when a Bakarwal family couldn’t follow this annual cycle due to the pandemic, they ended up losing their two children in Kashmir’s harsh winter.
Due to the intense cold, 10-year-old Sahil had developed a fever and became unconscious during the night hours of January 18, 2021. The family living in a makeshift tent in Kulgam district’s Brinal Lammar village was not able to take him to the hospital as the roads were cut-off due to the snow which resulted in his death.
The PHC was 3 kilometers away from their accommodation. Next day, their 6-year-old daughter also showed the same symptoms and died on way to the hospital.
As the incident sent shockwaves across the valley, the district administration shifted the family to rented accommodation.
“If the government had provided the accommodation earlier, those kids would’ve been alive, but like always, the officials always act late,” said Choudhary Irshad Khatana, a tribal welfare activist.
Passing the buck, Director Tribal Affairs J&K, Mohammad Saleem said the tribal family’s accommodation was the responsibility of the concerned district administration. “Our mandate is to just place the health infrastructure in place, while as putting the manpower in the health centers is the responsibility of the health department.”
Meanwhile, at the frozen heights of Fakir Gujri, daily-wager Manzoor Khatana is getting anxious about his tribe’s taxing health trips to Srinagar hospitals.
“The government under Janani Suraksha Yojana (JSY) grants one-time financial assistance of Rs 1400 to pregnant women for giving birth in a government hospital,” he said.
“But to receive it, most of us have to spend double the amount on travel to the Srinagar hospital!”