I enjoyed reading the article by Prof. Khuroo on "SKIMS: The myth of overcrowd" in GK columns on Nov 3, 2010. He has hit the bull in the eye by raising several valid issues. I strongly believe administration is playing with the numbers to hide their inefficiency and poverty of healthcare policies which are essential to improve SKIMS running. They are misguiding the public by publicizing these numbers. They also are pressuring Health authorities to pump in more funds by frightening them with numbers. Expanding services beyond SKIMS concept is irrational as elegantly depicted in the article. SKIMS was built as a hope to Kashmiri nation to deliver in a series of specific health activities in super-specialities not represented in State at that time in other medical institutions. This included state of art management for heart ailments (cardiology and cardiothoracic surgery), brain ailments (neurology and neurosurgery), kidney diseases (nephrology and urology), gut disorders (Medical and surgical gastroenterology), endocrine diseases (Medical and surgical endocrinology), and Cancer therapy (Medical and surgical oncology and radiotherapy). Many specialities represented in Medical college hospitals were not developed to avoid duplication of services and wastage of finances.
 Employees were given slogan of "say-no-to 10-to-4 job" and "say-no-to private practice". Modern lab facilities and imaging tools were procured. I believe SKIMS has around 4 CT-scanners of high quality. KFSHRC Riyadh (a tertiary care hospital which does 10 times the work load than SKIMS does and where Prof. Khuroo worked for 10 years) had only 2 CT-scanners and these cater to needs of this facility and many other cities of Saudi Arabia. Of course these CT-scanners work for over 18 hours per day and dedicated team of radiologists start work at 6AM and extend day till late hours. KFSHRC laboratory facility caters to needs of Institution and this lab had gone aggressively for private use to many cities in Saudi Arabia and Middle East to generate finances.  KFSHRC lab space is one fourth of what we have in SKIMS and has less advanced equipment than housed in SKIMS. To reduce the so called overcrowd in the institute, there is need to extend working hours. This will correspondingly increase the overall activity of the institute. This extension in working hours is necessary because of the nature and special purpose of the institute and the unique pay structure and facilities provided to the employees.  I agree with Prof. Khuroo that if an emergency department is build up in SKIMS, it shall create major problems in health delivery. SKIMS does not have so many back-up specialities which emergency department needs to support (ENT for nasal fractures and injuries; ophthalmology for eye injuries; orthopedics for bone fractures; obstetrics for obstetrics emergencies, paediatrics for children emergencies, psychiatry for such emergencies and so on). We shall have to introduce/duplicate all these specialities which are already available in Medical College to support this service. That means we have to reinvent the wheel of healthcare in SKIMS just to introduce emergency department. I would urge authorities to stop revolving around this number game, focus on health delivery issues and improve the services to tertiary level; the concept what SKIMS was and shall continue to be meant for. Of course overcrowding artificial or real can be managed internally by methods defined in the article or other means which administration may deem appropriate.

Dr. Farooq Ahmad
Dammam,
Saudi Arabia
ahmadfarooq3746@yahoo.com)

Lastupdate on : Fri, 5 Nov 2010 21:30:00 Makkah time
Lastupdate on : Fri, 5 Nov 2010 18:30:00 GMT
Lastupdate on : Sat, 6 Nov 2010 00:00:00 IST