Health sector is often
in news these days for various reasons but mostly for all the wrong ones. From
epidemic of Hepatitis C, swine flu, fake drug scams, infant deaths, issue of
private practice and the blame game. There are no statistics available about
the various diseases in community and hospitals are considered to be the answer
for everything. Public health department has remained restricted to medical
colleges and not where it is supposed to be. The question arises who is
responsible for this mess. The newly inducted health minister thinks making
doctors wear an apron is going to make the system work and some people do find
that appealing. As one of my friends wrote on Facebook ‘The "white
coat" is the divine remedy for all problems in health care according to
Lal Singh’. It is ironic that no one has actually tried to look into how the service
delivery can be improved. The valley has become open market for drug companies,
original or fake and is known to be the gold mine by pharma companies. The
state of tertiary care institutions including the medical colleges and SKIMS is
rather pathetic and are being run like the make shift hospitals in a war zone. Many
colleagues may not agree with me but I am not trying to take a dig on them.
United Kingdom is going
to elect new government in May 2015 and it is interesting to note that National
Health Service (NHS) is the main issue on which various parties will fare and
is going to be the deciding factor. I wonder when there is an election in India
or let us talk about Jammu & Kashmir; provision of health care never makes
even to the manifesto. People are never on streets to demand safe, accountable
and dignified health service. Politicians put all the blame on doctors and try
to malign and humiliate them, to reassure or rather deceive their voters. None of the previous governments has ever
tried to seriously review what is going wrong in spite of the reports of
multiple deaths and epidemic of infectious diseases time and again. The doctors
in their frustration, lack of resources and chaos seem to be in charge of
everything. They get busy with their work and never think of raising their
voices for common good. Some are involved in practices which would not be
acceptable if there was any accountability and proper procedures in place.
The fact is that the delivery of health care
in modern times cannot be down to doctors only and there is need for
multidisciplinary team approach where in various professionals play vital role.
A surgeon cannot operate alone, neither can a physician. The allied
specialities like nurses, pharmacists, technicians, heath care assistants, etc.
are as important as doctors for the delivery of proper heath care. It would not be any way justified to compare
the English NHS and our health system keeping in view the lack of resources and
ever decreasing budget for health sector.
The concept of primary, secondary and tertiary care has in fact come
from NHS. But though we seem to have borrowed the idea more than half a century
ago, no one has ever thought if it is practicable in our way of living,
resources and administrative set up. The promises of opening more AIIMS like
hospitals in state and neglecting the primary care is the worst thing possible.
It is the reason there are crowds of patients with all kinds of ailments
rushing to the SMHS and SKIMS like places when they could be easily managed in
community.
Having trained as a doctor in the state and
worked in both regions of the state, medical colleges, directorate of health
services and periphery, I am sure that just producing doctors and specialists
in not enough unless they are properly supported and utilised. The concept that consultants can be found only
in medical colleges and Institute is absurd. We are still stuck on the idea of
recruiting ‘assistant surgeons’, which was probably started by British when
there were only a handful of doctors. Politicians always moan that doctors do not
want to work in periphery, which is a fact, but have they ever wondered why. When I went for my interview for the post of
assistant surgeon held by public service commission and having trained as a
psychiatrist, I was told that ‘we do not want to know about your psychiatry,
you have done MBBS’ and was asked about surgical precautions in AIDS patients
and highest civilian award in India. No one asked me why do I want this job or
what can I bring into it compared to others. Passing MBBS does not make a
person ready to deal with all ailments in current day and age and most other
countries require further training for at least 3 years to work as General
Practioner. So if someone has trained as an ophthalmologist and is posted in
periphery may be a PHC, I wonder what he is supposed to do. Even if he is
posted in a district hospital and then left to do night duties on his own and
deal with various kinds of emergencies, how he is going to do justice with
that. No one wants to be guilty of killing people when he or she is supposed to
save them. The dilemma of working in
periphery is because doctors are expected to know all and treat all without
looking at their qualification and expertise. The result is most people are referred to
Srinagar to save the patient, and also the guilt if treated locally and
something goes wrong. As a psychiatrist
I am far from confident treating a heart attack, stroke, and injuries so if I
am forced to man the causality, how is that going to solve the problem.
Appropriate utilisation
of resources and more so of man power forms the cornerstone of current health
system. But as mentioned above, no one ever thinks about utilising the
expertise and experience of doctors but system is more interested in head count
and fooling the common man. Asking an ophthalmologist to treat fracture and a
psychiatrist to treat heart attack when there are enough highly trained doctors
in respective specialities who can do a wonderful job if they are supported and
allowed to do what they ought to do. It would not be wrong to say that the
problem starts from top. When choosing a health minister; no consideration is
given if he or she has any idea of the health care delivery in modern times.
The same effect trickles down in appointing various officials who do not have a
clue what health system is about.
It is time to think
beyond medical college and Institute, as these places are already working way
beyond their capacity and have lost the purpose for which they stand for. It is pertinent to say that huge amount of tax
payers money has been spent on constructing enormous structures at various
district hospitals across the state. But simply having a nice building does not
mean anything if you do not change the system, and have proper manpower and
human resources to run the place. The state produces more than enough highly
efficient doctors in various specialities and it is time to utilise them
appropriately.
A proper audit and
review of health care needs to be conducted.
It becomes the responsibility of medical professionals, more so of those
who have taken the academic posts in various medical colleges. Unless there is
some data it is hard to make proper appropriate recommendations. The assistant
surgeon system needs to be abolished sooner than later. The district hospitals
needs to have proper units of various specialties like medical colleges and causality
department needs to be run by doctors who are able to deal with type of patient’s
presenting out of hours or in emergencies , than any MBBS doctor. The specialists working in periphery needs to
be given the status of consultants than classifying them as B and C grade.
There is need of very
strong will from the political establishment to bring in the change and take
the responsibility of providing access to proper and safe health care. They need
to stop fooling people by false assurances without doing anything on ground. The people also have a duty to raise their
concerns and make health sector a priority than expecting doctors to do so for
them. Unless the political establishment is forced to make changes, simply
blaming doctors is never going to make anything better. Medical professionals need to put the house
in order, conduct research and reviews of current system and practices. Doctors also need to give up the idea of
being solely responsible for health care delivery and be inclusive of other
professionals. Unless everyone plays a
part, the simple blame game is only to cost poor lives than bring any positive
change.
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