I was lost for words. He sounded desperate, helpless and fed-up. He wants to serve his people to the best of his expertise but has become a victim of an unhealthy health care system, losing his skills with every passing day. Though he never thought of leaving his home, he is even considering moving out of the valley. As he narrated his ordeal, I kept thinking of hundreds of sincere doctors in his shoes, who want to alleviate the suffering of their community but are rendered unworkable by a corrupt and badly run health department. This is how the story unfolds.
After completing his MBBS, he decided to become a child specialist. While training as a paediatrician, he would often feel helpless seeing the pitiable state of neonatal care in the Valley. You may recall the headlines of hundreds of neonates dying not that long ago. There is not only lack of infrastructure and equipment but also a dearth of trained professionals like neonatologists and allied specialists. With this in mind, he decided to become a neonatologist. He left valley joining a specialist centre for a period of 3 years. That meant leaving his family and a few months old son at home. He missed his son’s babbling and the first steps. Whenever he would visit home, his son would refuse to play with him, taking him for a stranger.
While in the far off land, he used to dream day and night that once back; he will serve his people by starting a new era of neonatology in the Valley. He would often talk about the feats he was able to do in a properly run system, how even a few hundred grammes premature neonate, is saved by right equipment and professional help. But once back, things did not work as planned. He gathered that health authorities are more interested in the head count than competence and training of a professional. He was even not posted to a place which caters to children, nor has any equipment or infrastructure to allow him to do his job. Probably he is just supposed to collect his salary at the end of the month. Who cares about neonates or their worried parents? Moving from pillar to post, requesting and pledging the top officials in the department, he went unheard. Why would a highly trained professional, who declined job offers from across the world, be posted in a place where he will even forget his basic training? ‘Kareh Najjar Badasteh Gilkar’. Let me remind you that J&K was awarded for the best healthcare in India. You are free to believe.
Keen to serve and learn, he visited many health care facilities across the valley and interacted with his colleagues to understand how to work. But apart from disbeliefs, he did not achieve much. It became clear to him that postings and transfers are not done using any method, taking into consideration the qualifications or the training of the doctor or need of a particular area. It is usually based on who knows whom, sufarish, crony capitalism or the mood of the official at the time. No one thinks of the poor patients or the doctor in question. It does not matter if practically an unqualified person is treating you.
Many buildings along the national highway have been named as Trauma Hospitals. Interestingly, there is no trained doctor to manage trauma. Glorified load-carriers driven by untrained personnel are called as ambulances. A room, named as the neonatal intensive care unit, has a warmer, weighing machine, and zero number of support staff. He also came to know that a brilliant surgeon was transferred from a district hospital to a far-flung village, not because of his inefficiency but being upright who was trying to do good for his patients. A dermatologist was forced to manage complicated pregnancies and then blamed for the adverse consequences. There are hundreds such examples of a square peg in a round hole.
He came to know that wounds are being stitched with bare hands, putting both the doctor and patients at risk of infections like hepatitis C and B. When he suggested asking patients to buy gloves from the market, he was advised that “the vigilantes from the revenue department will be dispatched within a jiffy on the directions of the local henchman, to cut doctors to size". Who is at fault here, administration or the civil society is for you to judge. I am not advocating patients should buy anything when the healthcare is allegedly free. But who pays the cost for the treatment of rampant hepatitis C cases? Unsurprisingly, some do ask medical representatives to supply gloves and other equipment, as hospitals are always in shortage. Whom would you blame for the alleged doctor –medical representative (MR) nexus?
A consultant friend was encouraging him to join his native district. When they met last, he found his friend distraught. His friend had been lobbying to procure some equipment for the hospital, with intensions that a maximum number of patients will benefit from the latest technology. He was warned by a class fourth employee from the administration that he is a non-entity and should refrain from defaming the hospital. Trying to improve the facilities is taken as defamation; some would say it as progress. When he mentioned his plans (rather dreams) of starting a neonatal intensive care unit (NICU) to his colleagues, having trained in latest technology including use of high-end ventilators, there was a loud laughter, whether on him or his naivety, one cannot be sure.
Finally, he reached back to Srinagar rather dismayed. While lost in his thoughts, he boarded a bus. He had thought that buses are obsolete now and probably not many people use them. Within no time, there were more people standing in the middle than those apparently seated, and more people hanging by the doors than those trying to stand relatively straight, and sandwiched in the middle. He thought, contrary to popular belief as our leaders often claim, most are still economically deprived and socially unprivileged. How can people afford healthcare if boarding such unsafe is a norm?
The bus conductor was shouting at the top of his voice to get more passengers on board. Within no time the conductor started yelling at the passengers, who were virtually hanging, to close the door. How can we close the door when there is no space inside, someone shouted back? Despite knowing everything, the conductor kept on insisting on packing more people into the bus. When the bus reached its final destination, surely many people had their backs and knees in a condition needing repair. Once off the bus, he could relate the condition of the health department to this bus in the 21st century. Our health system is like an overloaded bus, and those supposed to administer the department, hardly care to change it.
One would have thought that administration is paid to improve the system and not just rule and control people by punitive postings and transfers. Isn’t it is up to the civil society to hold health authorities accountable than getting fooled by false promises of new hospitals which then fail to deliver for obvious reasons? It is time to get a proper system in place which is patient centred, professionals working as per their competence, and are held accountable for their actions. The department needs to utilise doctors as per their expertise, encourage and reward them than to punish them for not having right contacts. Let paediatricians look after children and ophthalmologists treat eyes, by forcing them to treat heart attacks or conduct deliveries, you will not only kill the patients but loose doctors as well. The opening of new medical colleges or announcements of model hospitals only makes sense when right people are chosen for right jobs. Otherwise, constructing concrete jungles only helps a few people to get rich and nothing more. Big buildings do not make good hospitals, but the professionals working in them do.
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