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30th May '2009
Non-Resident Kashmiris in Healthcare

A few days back while speaking in a Consultative Workshop on Public Private Partnership in Health Sector, Chief Minister Omar Abdullah called for a reversal of brain drain. He invited Non-Resident Kashmiri doctors to return to the State and improve healthcare facilities here. It is a very timely and positive step to motivate Kashmiri doctors serving abroad in world class institutions to return to their home country. In fact, some of these doctors have become super specialists and have excelled in certain fields. Some of these doctors have earned laurels in the field of Cardiology, Gastroenterology, Cardio-Thoracic Surgery, and some other specialities. One of our doctors is quoted worldwide as an authority on Gastroenterology. However, the invitation seems to give an impression as if the NRK doctors are not interested on their own in coming and serving in Kashmir. On the contrary a number of top specialists have been trying not only to come back to Kashmir but to establish state of the art healthcare facilities here. Unfortunately, their ventures have been blocked by some corrupt bureaucrats and even some ministers at every stage. For last couple of years a group of top doctors from U.K., U.S.A., and Middle East have been trying to get permission to set up an International level super speciality hospital in Srinagar but are now feeling frustrated because of unnecessary bureaucratic hassles and deliberate delays. Even the State Chief Minister who is the repository of all residual constitutional powers and has the discretion to give permission in relaxation of all rules in the larger public interest has failed to expedite their case. There are numerous other cases where some of the top doctors have given up their initiative in the face of these totally frustrating road blocks. For last many years Non-Resident Kashmiri doctors have been holding conferences in Srinagar wherein they have expressed their keen desire to come back to the valley to serve the local public but the bureaucratic red tape and rampant corruption has poured water over their enthusiasm. They too have given up their attempts in utter frustration.

In fact, as has been repeatedly pointed out through the media, the entire healthcare in the state is far below the accepted norms and standards. There are no two opinions that the system of healthcare needs a drastic overhaul in the whole state. Numerous articles, columns, news reports, and public grievance letters about the deficiencies in our Healthcare System have been written umpteen times. 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. The Chief Minister has also pointed out that there is a common complaint of doctors refusing to serve in rural areas. He specifically mentioned Gurez, Dachhan, Marwah, Warwan, and Tulail. We do have Health Centres in these far flung remote areas but we expect doctors and other staff to live in these places 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 are the sub-district and district hospitals. Again these are not what hospitals should normally be. These lack both in specialists and specialised equipment. The specialists refuse to serve in district hospitals because these are not teaching hospitals and service there does not count towards teaching experience. Most of the cases coming to these hospitals 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. One of the most visible aspects which one notices in our hospitals both in the cities and districts is the lack of dedicated nursing staff.

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! This applies to healthcare also. Without accountability we cannot think of proper healthcare. Let us take the example of western countries or even Middle East where a number of our doctors are serving. 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. Chief Minister in a subsequent statement asked the doctors in SKIMS to give up private practice. Here it is again a question of accountability. Private practice is totally banned for SKIMS doctors. They are being paid non-practicing allowance. Not to speak of stopping private practice outside the institute, they are doing it inside the hospital itself. Recently there was a case of a doctor demanding Rs. 5,000 from the relatives of a patient for treating him inside the government hospital. A probe had been ordered but the result is not known. Yes, private practice can be stopped if people get good treatment in the private sector on one hand and the doctors in the government institutions get emoluments for a decent living!

Returning to the topic of Non-Resident Kashmiri doctors, it is in the interests of the government to encourage and facilitate all those people who are interested in setting up world class healthcare facilities in Kashmir. In fact, government should also motivate some of the reputed hospital chains like Apollo, Fortis, Max etc to set up units in Srinagar by extending all facilities and incentives. It is only with the establishment of some world class facilities that the government institutions will get a tough competition and will have no option but to improve their working. It is an established fact that improvements can be made only when there is something to emulate. If we have the state of the art healthcare facilities in the private sector, the state sector will have to improve. The state sector operators can be directed to come up to the standards available in the private sector and in case of failure they can be taken to task. In order to improve the healthcare facilities the government will have to go for an all inclusive and comprehensive overhaul of the entire system. Ad hoc piecemeal measures will not do. Let us hope the welcome announcements made by the Chief Minister get implemented on the ground and in the shortest possible time. Needless to mention that this is the highest priority sector and without good health the whole society becomes sick both physically and mentally!

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