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8th February '2009
Agenda for Good Governance-IV

For “Good Governance” there are many essentials which have been highlighted in earlier columns. However, the basic and the most important ingredient of all the systems is a human being. Physical well being and good mental health is the fundamental necessity for a human being to deliver. An unhealthy person cannot be expected to develop and improve any society. Thus, the very concept of “Good Governance” of a State should start with the improvement in the health of its citizens. Numerous articles, columns, news reports, and public grievance letters about the deficiencies in our Healthcare System have been written umpteen times. Many attempts have been made to improve the set up but in spite of all these efforts the system has not shown appreciable improvement. On the contrary it has been deteriorating exponentially. One cannot hold the Department of Health wholly responsible for this deterioration. The malaise is much deeper. During last couple of decades the most conspicuous visible impact on state administration in all spheres of its activity has been the loss of discipline and accountability. No one is answerable to no one! The entire focus of the people in authority had been on the maintenance of law and order and catching or killing the illusive militants. One could take any liberty under the cover of security reasons. The basic amenities and civic services were given a go by or these were allowed to be deteriorated to such an extent that it now seems impossible to redeem these. Instead of pointing out more deficiencies, it would be rather worthwhile to give suggestions to improve the system. While talking of accountability one is reminded of regulations in the western countries or even in Middle East especially Saudi Arabia. If a patient under treatment dies in a hospital, there is an automatic inquiry into the cause of death and the role of the attending medical staff. If it is proved that a doctor or medical staff was at fault, he or she apart from losing the job and facing deportation can also be fined and sent to prison. In our case, there are almost daily deaths and sometimes even on the operating table which totally go unnoticed. Regarding administration of drugs, in the west if a patient in a ward is put on an antibiotic, the entire ward is on red alert. On the contrary, here any kid can buy a third generation anti-biotic over the counter and take it on his own. The Health Department needs to enforce the Drug Control Act vigorously to avoid complications by indiscriminate use of drugs by common people as well as the free circulation of spurious drugs. Drugs especially ones having severe side effects should in no case be dispensed without a proper prescription of a licensed medical practitioner.

To begin with, we have to improve the Primary Health Care which is not up to the mark. The Primary Health Centres have to be fully equipped both as regards the staff and equipment. There is common complaint of doctors refusing to serve in rural areas. We have Health Centres in far flung remote areas where we expect doctors and other staff to live on a punishment basis. In the deserts of Arabia, there are Medical Centres even in remoter areas but the facilities provided there are better than those available in the major metros of the country. The very same doctors who refuse rural duties in Kashmir gladly serve in the desert centres. It is not only because of higher emoluments but because of good living facilities available there. Why can’t we recreate similar facilities for our doctors in far flung areas? If it is made more lucrative and comfortable to serve in remote areas people will gladly opt to go there. Next come the sub-district and district hospitals. Again these are not what hospitals should normally be. These lack both in specialists and specialised equipment. Most of the cases have to be referred to the City Hospitals. This is worse in regard to maternity cases. There is only one hospital in entire Kashmir and that is by now the most infamous “Lal Ded” Hospital. Totally over loaded and virtually in shambles. Same is the case with the Paediatric Hospital. The only one in the valley is an apology of a Children and Maternity Hospital. A number of reports have appeared about the status of these hospitals. In fact, the very first act of the new Chief Minister was to sack the top brass of Lal Ded Hospital. It is not difficult to maintain district or sub-district hospitals at a reputable standard. Only will to do so with the support of higher authorities is required. In late seventies when I was supervising winter sports in Gulmarg, the sub-district hospital at Tangmarg was kept in excellent shape by the then superintendant, Dr. Sheikh Mustafa Kamal. The centrally heated hospital was probably the first to have an auto-analyser! The reason for specialists avoiding district hospitals is the fact of these being non-teaching hospitals. The tenure of a specialist there is not counted as teaching experience required by him for promotion to higher posts. Unfortunately, we have a tendency to locate every important facility in Srinagar only. This is true not only in Health sector but in almost all spheres. If one plots the growth of our urban areas on a map, the Srinagar City is like a football where as the other towns are no more than pinheads. Even in the City of Srinagar there is total dispersal of various specialities. Specialities concerning various parts of a human body are located in four corners of the city. The super-speciality institute, SKIMS, is operating as a normal hospital than a super-speciality centre because of the tremendous out patient load.

Kashmir does not have an ambulance service. In many other countries or even some of the metros the ambulances are so well equipped that a patient gets half the treatment during the journey to the hospital. In our case, many a patient may not survive the ride to hospital in view of the condition of the ambulances. One of most visible aspects which one notices in our hospitals is the lack of dedicated nursing staff. In any hospital, the success of treatment depends upon the post operative care. We have excellent consultants and some of these can be rated among the best in the world but their efforts go many times waste because of the lack of post operative care. If we do not have good nursing staff, why can’t we import good nurses such as the Keralites famous all over the world? This is more relevant in view of the massive import of both skilled and un-skilled Bihari labour. One suggestion for improving the facilities provided both by government and the private hospitals is to allow setting up of some international standard institutions in the state. These can be a bench mark for others to improve. For some unknown reasons the vested interests have not been allowing such establishments even by some non-resident Kashmiris desirous of serving their own people. An instant case is the permission to set up an International Hospital by some Kashmiri doctors from USA, UK, and Middle East which has been in the pipeline for last couple of years. It is reported that some politicians had demanded heavy bribes from them for giving the requisite permission!

Apart from Health Care, Civic Services like Municipal Services, Traffic, Drainage, there are umpteen other sectors involving basic amenities for the common people which need to be attended to urgently as part of “Good Governance”. There are other areas like Education which need attention. However, detailing all these would require writing a full fledged book on “Good Governance”. One would like to conclude the present series of the articles with the sincere hope that the issues already raised would get due attention of the concerned authorities. Depending upon the response it may be worthwhile to discuss other aspects especially pertaining to Civic Services in some future columns.

(… be continued.)

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