We want AIIMS. This is a common slogan from every region and district of Jammu and Kashmir these days. I am not sure whether it is about health, politics, regional hegemony or keeping people distracted from the lack of basic health care facilities in the state.
It has led the civil society of Jammu to unite and do whatever they can to claim the proposed AIIMS.
Every political party is trying to take credit, doesn’t matter which region it goes to. The Jammu faction of the ruling BJP-PDP coalition has given in writing that they will get an AIIMS for the region and the Panthers Party is marching to Delhi to demand its own. It has also become a tool for furthering the regional divide in the state. I wonder why people from Ladakh region are still silent.
Similarly every district of the Kashmir valley wants AIIMS. Social media is full of debates why it should be in south Kashmir, why not in central Kashmir and how north Kashmir best deserves it. People from Chenab valley are making similar demands. However the question remains whether AIIMS is really the answer for poor health care delivery in the State?
I am not against the idea at all and do believe it will help a good percentage of patients with life threatening and long term illnesses and there is a need for more tertiary care hospitals.
What is wrong with the institutions we already have like GMC, SKIMS and the super-speciality hospital in Jammu? How do you think AIIMS would be any different from SKIMS? What happened to the four proposed medical colleges which were starting in the State? Was that promise also a political gimmick for attracting the vote bank.
The Children’s Hospital is again in news for increased death rate of neonates and so is the lone maternity hospital for overcrowding and related issues.
Before projecting AIIMS as the magical cure for all our health problems more needs to be done to improve the peripheral health service.
Otherwise it is like starting a new university as a substitute for failure in primary education and replacement for primary schools. The notion that the tertiary care hospitals should treat every condition while ignoring the primary health sector, defeats the very purpose of AIIMS like hospitals.
Would people not queue there with minor ailments like tummy ache and running nose? Would the super-specialists be able to treat those with terminal illnesses, rare diseases, life threatening conditions , organ transplants , do open heart surgeries, cancer treatment just to name a few ? Or do you want them treating common cold, flu, itch, loose stools and subsequently turning it into another over crowded health facility.
Hospitals like AIIMS or SKIMS are meant to treat only those patients who have been seen in the primacy care and are in need of specialist help. Or those who cannot be treated locally and need specialist intervention for a life threatening conditions.
That means people who are referred by the doctors from the primary care ought to be seen and treated. We cannot have walk-in OPDs as is happening currently and then expect these institutions to deliver. But here also we cannot blame the poor patients for queueing at tertiary care hospitals.
If the appropriate services are made available at the primary care and referral system is streamlined, then only will it be possible to let these tertiary hospitals to work optimally and help those who actually need such kind of facility. But are we ready for such a system, keeping in view the lack of accountability, mismanagement, corruption and nepotism? Would it cause poor patients further suffering, would they have to go from pillar to post to get referred?
In most of the developed world, primary care system manages most of the ailments from hypertension, diabetes, depression, anxiety, pain, asthma etcetera and people are only referred to tertiary care if not manageable locally.
But unless we have a functional peripheral health system, no matter how many AIIMS are opened up, they are likely to have the same fate as the existing hospitals. One then wonders why nothing is being done or said about the peripheral health sector.
We often hear accounts of deaths in various hospitals leading to beating of doctors and ransacking of property. At times professionals are randomly arrested to calm down the situation. Anyone from a village headman to a revenue officer feels entitled to boss around and order dismissal of staff, which speaks volumes about the actual disarray in the system and lack of seriousness from the authorities.
There is no health policy and every new government bins the plans made by previous regime like the four proposed medical colleges. Would it not be worth reviewing the current peripheral health structure and upgrade the facilities according to the needs of the area than how influential the local MLA is? Is it not time that all the district hospitals are upgraded so that no patient is referred to tertiary care hospitals unless there is a real need and cannot be managed locally?
By upgradation, I do not imply constructing oversized buildings, which our ministers are good at for reasons you know better. Upgradation means appropriate allocation of adequate resources, recruitment of staff and doctors, creation of specialised units and starting of well-equipped accident and emergency sections at every district hospital. There are enough trained and specialist doctors in the state to fill in these roles.
With the ongoing neglect and failure of providing basic healthcare in the state, we surely need more AIIMS like hospitals in coming years. There is an epidemic of hepatitis C in the valley which has been completely ignored by the authorities. People are being infected on daily basis and majority have no access to any treatment.
If nothing is done sooner, within a decade or two, there would be thousands of people with terminal liver disease who would need AIIMS like hospitals and much more. Similarly the uncontrolled use of antibiotics, fake drugs, unhealthy lifestyle, obesity, drugs and alcohol addiction, environmental pollution, adulterated food products and road-traffic accidents leading to debilitating injuries etcetera would lead to conditions which will need more specialised hospitals.
But if there was any political will and demand from the civil society, most of these conditions could be prevented and treated locally. Communicable and infectious diseases like hepatitis B and C could be curbed if department of Public health (community medicine) is utilised beyond the borders of medical colleges so that they can conduct proper epidemiological studies on local population and come up with appropriate preventive strategies based on the resources available.
To conclude it is important that people demand equitable, safe and dignified health care first at primary and secondary level and then dispute about AIIMS type of facilities and its location. So while the politicians play with your emotions using the issue of AIIMS and new medical colleges, it is time to demand a proper upgradation and necessary review of the current hospitals and peripheral health system.
If there is a functioning primary health system, proper referral structure and the walk-in-clinics are closed down; even the existing facilities at SKIMS can do wonders for those who actually need them. But surely there is need for more tertiary care hospitals to cater to the growing population and a health policy based on facts and needs than whims of political parties for vote bank politics.
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