No Blame Game Please!

Kashmir is not new to disasters whether natural or man made. From conflict, snow storms, earth quakes, epidemic infections, fake drugs, active deforestation, unplanned constructions and the floods to name a few. Every time something happens, there is an unprecedented response from all corners of society.  The state government also pretends to be acting and working round the clock. The media is busy in highlighting the suffering of masses. There is severe criticism of respective departments for not being ready, acting appropriately and in timely manner. Self-help groups and charities mushroom all over the place in no time. Most importantly people show resilience, help each other, put their lives at risk for others and the society seems like a one big family in distress. There are exceptions to this with some taking advantage of suffering people by manipulation, stealing, blackmail and what not.

Following the crisis phase, the cohesion dwindles slowly and people get busy with their routine lives. Media tries to keep the issue going for a while. Politicians blame each other for the disaster and its mismanagement.  Some alleged scholars even try to blame the younger generation especially the women for the disaster. The actual victims of the disaster keep crying for help, making rounds of offices, paying bribes and using any political connections to get some relief. But within few months, the whole society goes into a state of slumber. The State asks Centre for a financial package which is rejected without fail. Package for flood victims, hepatitis C and even for upgrading the ailing drainage system of Srinagar city are few examples.

Kashmir is not the only place in the world facing disasters, but for one reason or another, it is a place where after a knee jerk reaction, people stop thinking once the crisis phase is temporarily over. Time and again there are sincere calls in local newspapers by experts about lack of appropriate policy, warnings of impending disasters and calls for preparedness to minimise the loss of life and property. But often all the meaningful voices go unheard. The changing global climate, issues with global warming, changes in seasonal patterns, aggressive deforestation, ever increasing pollution, use of polythene bags just to quote few have been known from long now and our valley is not immune to such changes.

So where lies the problem? Looking at the pattern of any disaster, we are still not able to move on from the blame game phase. Some blame the Almighty for everything; many blame the same government that they voted to power and there are still many that start blaming the central government.  Some invoke the sins and even do not spare their own daughter’s for the alleged wrath of God. Government departments blame each other for unpreparedness, poor response and lack of responsibility.  The weather man tries to reassure people without any evidence, trying to keep his superiors happy. Flood control department hardly seems to have a clue when to declare an emergency. They sound the alarm at midnight, when water has already reached above doorstep and keep reassuring people during the day that there is no need to panic.  The rescue operations get politicised, heroes and villains are made depending on loyalties.  The alleged disaster cell at the divisional commissioner office goes under ground.  The State even gives in writing to the Supreme Court that there is no crisis and we have all the means to deal with any situation.

With increasing population and people migrating, new colonies have erupted left, right and centre. The land mafia has its way of selling any kind of land for any purpose and at any place. It is not difficult to get planning permission for those who buy this land at sky high prices by spending a few more bucks or use political influence.  Any new colony in the city looks charming by the architecture and size of the houses.  But I am not sure the planners, government or the people who settle there, ever think of drainage, roads and other basic amenities. Same is the situation with illegal constructions on the dying Dal Lake. The rivers either big or small stand neglected for decades and by now have enormously shrunk in size and some may cease to exist soon. Constructions have been allowed in places which put common sense to shame. Even government offices and hospitals have been erected at sites where no preventative measure can prevent a catastrophe of flash floods. Active and merciless deforestation is going on by mafia, smugglers with cooperation of forest department and politicians, pushing the whole ecosystem in imbalance and resulting in floods and loss of life.

So who is responsible? The common man or those voted to manage the affairs of state? This is a complex question. But to be realistic, the final blame lays with all of us. We clean our houses but leave the junk in the street.  You can see that first hand even in the most affluent parts of city. We construct houses in summer but ignore the fact that a winter is coming.  People who govern the place do not come from another planet and they are voted to power by very same people whom they don’t care for, once they are in office. The society has a skewed opinion, the more corrupt you are, the more respect you are given. Corruption has become the basic unit of local economy and has been morally, ethically and religiously legitimised.  People with some integrity are classified as dry and rigid. They are made to suffer and are side lined so that they do not hinder the business of the majority.  People come on streets to protest against installation of electric meters but they do not find day to day scandals and corruption as a matter of concern. In short the pathetic state of affairs boils down to corruption, which in turn leads to lack of accountability and the continuation of vicious cycle.

We do not want any responsibility.  We tend to stick our heads in the sand and expect other people to sort our problems. We claim to be obedient servants of God within the places of worship, but ignore the basic teachings when it comes to dealing with interpersonal affairs and fulfilling the responsibility towards the society at large. I wonder if there is any other reason apart from creating jobs for having departments like that of  Flood Control,  LAWDA, Forest or Drug Control to name a few. In fact they do more harm than good by creating a false sense of security.

The most important thing to note is that we repeatedly fail to learn lessons from our past. Civic sense has died a very painful death and we cannot even queue without a man in uniform holding a stick to our head.  Somewhere we have lost the art of introspection. But in no way is it too late to start again. Things can be changed, disasters can be prevented or at least minimised, and lives can be saved only if we start thinking beyond ourselves and our high walls.  The elected representatives need to be accountable and if they fail, they must resign for being morally responsible for the ill happenings.  The state government in turn has to lead its people towards positive direction, curb the corruption culture, find ways to make people accountable and punish those acting with negligence. We need to come up with long term solutions for the ongoing disasters.  If we fail to introspect, wake up and reflect, then it is inevitable to see many more disasters sending the place into further chaos.

http://www.greaterkashmir.com/news/2015/Apr/2/no-blame-game-please--4.asp 

Who is responsible?

India is a world leader when it comes to manufacturing and sale of fake drugs.  According to the World Health Organization (WHO), one in five drugs made in India is fake.  The American Food and Drug Administration (FDA) held a series of raids in India recovering large quantities of substandard medicines and concluded that the penalties for making and selling such drugs are minimal, the convictions rare, and the profits enormous. We have companies manufacturing antibiotics and rat poison in the same facility, resulting in death of many innocent women. India’s reputed Ranbaxy pleaded guilty to felony charges and paid a $500 million fine last year, the largest ever levied against a generic company. India’s Central Drugs Standard Control Organization, the country’s drug regulator, has a meagre staff of 323 people, about 2% the size of the FDA.

Kashmir has become a notorious hub for spurious drugs in India.  Hundreds of deaths at the paediatric hospital are thought to be due to these drugs, with New York Times calling it a ‘targeting of vulnerable’.  In 2013 fake drug racket was unearthed in Kashmir.  Thousands of fake tablets had been supplied to main hospitals in valley including lifesaving antibiotics. Further, 24 drugs were declared as ‘not of standard quality’ by the Government Analyst of Central Drugs Laboratory, Kolkata. The Health Minister at the time Taj Mohidin blamed his party colleague Sham Lal Sharma for the scam.  The chief minister ordered a probe. Few people were arrested from Jammu. The medicines had been purchased after approval by the purchase committee in the Health Department. Various doctors associations alleged that high-ranking officials from health, drug control and other departments were hand in glove with drug mafia, and demanded a high level independent probe. There was severe outcry from civil society, politicians and separatist leaders.  Even after public interest litigation (PIL), there has been no probe.  One of the whistle blower doctors had to face suspension allegedly for demanding justice and punishment for guilty. The probe died a natural death with Mr Lal Singh becoming the health minister.  

Lal Singh does not seem to have any faith in doctors, which questions his intentions for seeking health ministry. How can a department work when there is no mutual respect or trust?  Doctors are held responsible for all the failures in health sector including the evil of fake drugs.  An order was recently issued that doctors should prescribe by writing only generic names, and were threatened with consequences for acting otherwise. It seems the fake drug mafia have succeeded in their mission to run the racket freely with the support of people in power. I am not here to advocate for doctors and there are many black sheep who engage in unethical practices. But even common sense is put to shame by this simplistic approach of a complex problem. From the manufacturers, distributors, retailers, chemists, approving agencies, drug controller department, purchase committees, health minister, medical representatives (MR), and finally doctors, how was it decided that only the doctors are responsible for this heinous crime? May be you can answer this question?  

In a civilised world it would have been a welcome decision that generic names should be written and MRs kept away from hospitals. But from my experience of working in both the Valley and West, this seems to be the beginning of another disaster.  All doctors write generic names in United Kingdom and MRs are rarely seen.  All the prescriptions are written on prescribed format according to the guidelines by British National Formulary (BNF). All the pharmacies are run by qualified and registered pharmacists. Full details of patient, doctor and medicines prescribed are recorded. There is record of every pill issued and can be audited anytime. All medicines are free for children and elderly and rest have to pay nominal fee. All medicines are free for inpatients. The entry of the drugs into the market is controlled and monitored. There are clear guidelines from the National Institute for Health and Care Excellence (NICE) about every disease and medication to be used. 

Meanwhile in J&K, even the order issued is one liner; no guidelines have been issued either for doctors or chemists. If a patient goes to the chemist with a generic prescription, how do we know what the poor patient is going to get? Under what code of ethics are these chemists working?  Has government released any guidelines for them?  Who would monitor what are they going to sell? Have these shops been told to record all sales, names of patients, drugs and the prescribing doctors?  If there is no audit trail, how are you going to make people accountable? What about drugs which come as combinations?  If we are going to adopt the ways of the West, we cannot just pick one thing from a package, it is doomed to fail. Would drug mafia not corrupt poor sales men to work for them and sell whatever they want?  What would happen when a patient’s condition does not improve, should the doctor send him back to the chemist? Finally if something goes wrong who is responsible, doctor or the medical shop owner?

Still no one has been held responsible for the fake drug scam. How is this generic names saga supposed to sort anything out? Coming out of SMHS hospital gives a feel of fish market, scores of men outside the chemist shops literally pulling the patients into their shops. Can we even call these corner shops as pharmacies? Thousands of such shops have mushroomed all over the state, mostly run by barely qualified people, with no training whatsoever. There may be few dozen genuine medical shops with a qualified pharmacist. I am not sure the state has actual number of medical shops on a register.

When the manufacture, supply and sale of fake drugs continue, how on earth is generic prescription going to make anything right? If the government was really serious, it would not have supplied its own hospitals with fake drugs. All illegal shops would have been shut by now.  It would have made sure that only credible and licenced drug companies are allowed in the state.  Exemplary sentences should have been given to drug racket kingpins so that others learn a lesson. But we all know what happened to that probe! Also, if all the drugs in the market are approved by the drug controller how does it matter which brand is written, unless it is hurting the interests of fake suppliers? The drug controller department seems to exist only on paper. Even if they work 24 hours a day and inspect all the shops, they would not be able to monitor a small block let alone the whole state.

Doctors know by experience that there are substandard drugs sold and that’s why they often ask their patients to bring back the medication to check, making sure it is not substituted by something made in a kitchen around Bishna or Hazratbal.   Some may argue that they do so to promote a particular brand which may be the case sometimes, but in majority of cases doctors want to make sure their patients improve. This is the only way of maintaining some quality control as authorities have failed or even collaborated with fake drug mafia.  The allegations that few doctors get paid or receive gifts cannot be denied but should not be generalised to malign all. Why not take strict action against those doctors who indulge in malpractice? If the patients trust their doctors in diagnosing, prescribing, going under the knife, what happens to the trust here?  Clearly this order is an eye wash to make people believe that government is doing something.

Trust between a doctor and patient plays a huge role in recovery. Lal Singh should have tried to bridge the gap between doctors and patients than playing political gimmicks at the cost of poor lives. The chief minister Mr Mufti Sayeed should take stock of the situation before another disaster comes to haunt us. The department needs to be cleaned of corrupt people, irrespective of their position or designation. Drug control department needs to be strengthened with adequate staff.  Strict laws need to be enforced, including charges of homicide against anyone dealing or supplying fake drugs.

Finally, people need to understand the deceptive tactics of authorities. Why do people have to buy medicine from market if health care is free? Why are thousands of hepatitis C patients still waiting for treatment for the last 2 years? Why do we need so many chemist shops? Blaming doctors or creating a wedge in the doctor-patient relationship is not the solution but an escape route for cheap electoral politics.

http://epaper.risingkashmir.com/EPaper.aspx?Ku9rli1P3JqqCV92v9q4UA_ep_ep

Un-Healthy State of affairs

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.

http://epaper.risingkashmir.com/EPaper.aspx?AMFRUx6jOLJo9HczJr_bs2WQ_ep_ep

Hepatitis C and Right to Life

Hepatitis C virus outbreak was reported from a few villages of Kokernag, Anantnag more than two years ago followed by an epidemic of cases and ongoing new cases in many neighbouring villages.  More than 800 cases are positive in just two villages Takia Magam and Sonabarie.  Many deaths have been reported so far.   Many teams were dispatched to the area under media pressure to start with but as the media’s interest dwindled, so did the attention of the authorities.  The poor villagers have been abandoned without any hope and are living with fear and stigma.   Some have sold their valuables and land to get whatever treatment is available pushing them further into poverty and ill health.

Unlike infections like flu, where herd immunity breaks the transmission cycle, blood borne infections like Hepatitis C will continue to spread until a source is identified.   People can become infected with the Hepatitis C virus by sharing needles, syringes, or other equipment to inject drugs, needle stick injuries in health care settings, from mother to new born and rarely by sharing personal care items such as razors or toothbrushes and having sexual contact with a person infected with the Hepatitis C virus. As per Centers for Disease Control and Prevention USA (CDC), of every 100 people infected with the Hepatitis C virus, about 75–85 people will develop chronic Hepatitis C virus infection; of those, 60–70 people will go on to develop chronic liver disease, 5–20 people will go on to develop cirrhosis over a period of 20–30 years and 1–5 people will die from cirrhosis or liver cancer. Mind you this data is for developed countries with abundant resources and such outbreaks are unheard of.  In view of lack of local research data, delay in treatment and poor health, the results are likely to be much worse.

Although it has been more than two years now, no one has been held accountable for the spread of this infection.  Various departments have been pointing fingers at each other, trying to pass the buck.  The fact is that this infection does not spread unless there is direct inoculation into the body.   Some of the local medical shops were held responsible initially and closed down, but have been allowed to open again.  It is ironic, that in spite of such huge number of cases, the authorities have failed to commission a proper investigation looking into the source and the way it is spreading.  If the reason behind this out break is not known, how will future cases be prevented?

Similar outbreaks have been reported in other districts of the valley including the old city in Srinagar. At least sixty people have been diagnosed with Hepatitis C in Wehal hamlet of Shopian district in last few months.  In Kokernag itself, many more villages are affected; the actual number of positive cases running much higher than the official stand.  In village Sagam Kokernag, hundreds are positive and the same is the case for other adjoining villages.  People talk in whispers that ‘he or she has tested’ with mixed feelings of sympathy, shame and stigma.  I was surprised to note one of my neighbours on Aciloc tablet prescribed by a senior physician. She was reassured that she is going to get better by her doctor. After initial disappointment I appreciated the wisdom of this physician. He knew that this poor lady would not be able to afford the actual treatment and telling her the truth would make her life more miserable. These people have suffered physically as well as emotionally. Some of them are being discriminated out of ignorance and at times by the medical professionals fearing infection. No one has thought about pregnant mothers and new born children. 

The average cost of initial treatment is about two lakh rupees which most of these poor villagers cannot afford.  There have been proposals from the State to Centre for financial aid which has been declined. The previous government had announced some package but that too has become the victim of unending bureaucracy. Even if this money is released to the treat the current cases, there is no plan for preventing the infection further. What about the new cases coming up on daily basis? With delay in treatment many of them are going to develop long term complications. Nothing has been said about managing and helping such patients with chronic disease.

Even if local chemists and self-styled dentists are spreading the infection, the onus of responsibility still lies with the State. Firstly, why are they allowed to operate and if they are really responsible, why are they still operating? These untrained corner shops selling medicine are the first port of call for people in far flung areas for obvious reasons. This brings us back to the question of provision of primary health care on the ground. Let us be honest, the number of primary health centres (PHC) is far less than the population needs. Even at places having a PHC, dentistry has been left out in spite of having enough unemployed dental surgeons in the state. I am not talking about having doctors available everywhere, all the time, but the system needs to at least make sure trained nurses or technicians are available so that people are not pushed to quacks. I am not aware of any programmes of imparting regular training to health professionals working in the department of health and medical education about infection control.  What is the guarantee that this infection is not coming from places run by State, how often are the sterilisation procedures audited?  Testing health workers for infections like HIV, Hep B and Hep C is mandatory around the world but not here.

This brings the question of responsibility and criminal negligence on the part of authorities. From various news reports it seems that the department of health, local administration, drug controller department, department of preventive and social medicine, SKIMS, Pharmacists Association Anantnag have been blaming each other.  The Draft Health Bill 2015 has proposed to declare health as a fundamental right.  Article 21 of the Indian constitution declares right to life as a fundamental right and State has a responsibility to safeguard its citizens. Billions of rupees are spent on defence to protect the life of citizens. But when the same citizens are under attack from a silent killer, the State becomes a silent spectator, undermining the basic human right to life and health.  There is enough case law to back this up. The issue of adequacy of medical health services was addressed in Paschim Baga Khet Mazoor Samiti Vs State of West Bengal.  The question before the court was whether the non-availability of services in the government health centres amounted to a violation of Article 21.  It was held that that Article 21 imposes an obligation on the State to safeguard the right to life of every person. Preservation of human life is thus of paramount importance.  Failure on part of a government hospital to provide timely medical treatment, to a person in need of such treatment results in violation of his right to life, guaranteed under Article 21. Therefore, the failure of a government run health centre to provide timely treatment is violative of a person’s right to life. It has also been held in this judgement that the lack of financial resources cannot be a reason for the State to shy away from its constitutional obligation.

 Following public interest litigation (PIL) last year, court was given assurances but nothing has been done since.  Courts are the last resort to direct the authorities to act and to charge the people or authorities responsible with criminal negligence. The victims need to be compensated not only for treatment, but also for the psychological trauma suffered by them and their families. The local police must take cognisance and lodge an FIR for further investigations.

The health ministry must clarify who is responsible for treating the current cases and also for preventing further cases.   Ruling party PDP has been vocal about this issue when in opposition but it is time for them to act now.  If this type of outbreak had happened in a responsible state, many heads would have rolled. The ex MLA Kokernag failed to bring much relief to his voters.  The current MLA Kokernag Mr Abdul Rahim Rather has an uphill task to safeguard the life and health of his constituents.

The departments of microbiology and community medicine need to conduct robust epidemiological studies so that the origin of infection and its spread is known.  The department of Public Health (community medicine) which is restricted to medical colleges needs to be expanded to health department.   Reporting of, and documenting all the positive cases in a central register should be mandatory.

The Health department should audit and review all the health facilities in the areas checking for any contamination and source of infection.  Health workers need to be tested for their own safety and safety of others.  Regular infection control training for all the staff dealing with patients is also necessary.  A long term strategy for controlling the spread of this infection or similar infections across the state should be formulated and made public.

Education will play a big role in preventing further spread of the infection.  Religious leaders, Imams and known elders can be trained to spread the message in local communities. The department of education could organise seminars and workshops in schools to make the younger generation aware about such infections and its prevention.  

The civil society too must take this issue seriously like other cases of human rights. State human rights commission needs to take account of the situation.  Last but not least, people and members of civil society must demand from their elected representatives their right to safe, accountable and timely health care.

http://epaper.risingkashmir.com/EPaper.aspx?M1_ppiU765mhWpH_pplLSFnZYQ_ep_ep

Under the Knife

Indian doctors are well known around the globe for their talent, dedication, hardwork. Many have become great administrators, researchers and role models. But doctors have become an easy target when anything goes wrong with in the health system in India.

Health care in India has been solely equated to doctors and they seem to be responsible for everything when it comes to delivery of health on ground. But when it comes to policy making and allocation of resources affecting the health care of more than a billion, the doctor community is kept at bay. This is down to the VVIP culture and the all-knowing mentality gifted by British and inability to let it go.
The Indian Medical Association (IMA) unlike its counter parts in other countries like British Medical Association (BMA) has failed its purpose and most doctors do not identify with it. In UK, BMA plays a major role in health policy and works closely with department of health. It influences most of the policy decisions including salary, working hours and staffing levels.

The Medical council of India (MCI), in addition to maintaining medical register is responsible for the quality of medical education and training, which it has completely neglected. If one tries to find the curriculum and syllabus for any speciality, trust me it only leads to disappointment. The examination system is archaic. Although medical science has changed completely in last 50 years, we
are still carrying on with the system which was in place at the time of independence. There is no effort on personality development, communication, ethics and research. There is no support for doctors in training and bullying is quite prevalent. It has also failed to make doctors accountable for their actions and one off registration for life time is offered without any reviews and revalidation as is
common in most developing countries.

There are innumerable challenges when it comes to working as a doctor. Indian health system is supposed to be free and based on three tier primary care, secondary care and tertiary care as is in United Kingdom. Having worked in both India and UK, one could see how in India the system is on paper only. The primary care is mostly defunct and even if doctors are posted in meagre number
of primary health centres (PHCs) catering to a humongous population, the resources in terms of manpower, essential drugs, equipment is next to nothing. For the same reasons doctors feel reluctant to work in the rural set up fearing loss of skills and negative impact on career progression. We are still expecting newly qualified MBBS doctors to work independently and man any situation, which is actually unfair on them and their patients. Most countries have further training of at least 3 years for doctors to become general practitioners (GPs), who in return form back bone of the health system and manage all kinds of ailments in primary care.

Also the situation with district hospitals is not any great. As the primary care fails, patients usually rush to bigger centres. These hospitals are run on similar lines and specialists working there are not given due support, career progression and resources to do what they are qualified to do. This has led huge pressure to tertiary care hospitals. People walk into any tertiary care hospital with
minor ailments which could easily be managed in community if the system is put in order. The referral system is completely broken and poor patients cannot be blamed to pitch at tertiary centres.
Although doctors form an important part of health system, they can’t act in isolation in current day and age keeping in view the advances in medicine. There is a need to inculcate culture of multidisciplinary team work and inclusion of other allied professionals like nurses, pharmacists, physiotherapists, social workers etc. Health spending is still in pennies compared to rest of
the world. Common man needs to make health as a priority and force their elected representatives to bring in the change. The draft National Health Policy 2015, has proposed a target of raising public health expenditure to 2.5 % from the present 1.2% of GDP. It also proposes making health as a fundamental right, which is a welcome step.

Dr Mudasir Firdosi is working as a psychiatrist at South London and Maudsley NHS Trust and Institute of Psychiatry Psychology and and Neurosciences (IOPPN) London. http://healthanalyticsindia.com/healthanalytic/dr-mudasir-firdosi.html