In the Indian context, a PHC is the first contact point between a particular community and the medical officer. The PHCs were envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotional aspects of health care. The PHCs are established and maintained by the State governments under the Minimum Needs Programme (MNP)/ Basic Minimum Services (BMS) Programme.
As per minimum requirement, a PHC is to be manned by a medical officer supported by 14 paramedical and other staff. Under NRHM, there is a provision for two additional staff nurses at PHCs on contract basis. It acts as a referral unit for 6 Sub Centres and has 4-6 beds for patients. The activities of PHC involve curative, preventive, promotive and family welfare services.
At the national level, there are 24855 PHCs functioning (i.e. 16613 PHCs and 8242 HWC-PHCs) in rural areas as on 31st March 2019. There is an upgradation of 8242 of PHCs as HWC-PHCs. The significant number of conversion of PHCs into HWC-PHCs have been observed in the States of Andhra Pradesh (1145), Uttar Pradesh (946), Odisha (827), Gujarat (772), Tamil Nadu (716) and Telangana (636). Significant increases in the number of PHCs have been seen in the States of Karnataka (446), Gujarat (406), Rajasthan (369), Assam (336), Jammu & Kashmir (288) and Chhattisgarh (275).
Percentage of PHCs functioning in Government buildings has increased significantly from 69% in 2005 to 94.5% in 2019.
The question that stares all of us in our faces in all this is that ‘what have we achieved in terms of a quality and robust pro-hospital incident or trauma management?’.
The popular belief that a commoner harbours about a PHC in Kashmir for instance is that of an immunisation centre, an address for ‘social medicine’ as we may like to interpret or at the most a place manned by a ‘popularly compassionate Medical Officer’. Case referral and then an audit of these referrals has always been a contentious issue for us in Kashmir. The relative amount of success we achieved in streamlining this was during the recent COVID crisis, when we were pushed by the circumstances to rationalise bed capacity across the board.
Trauma centres are vital community assets. When we or someone we love is severely injured, having a fast access to specialized physicians, nurses, resources and equipment can translate into a difference between disability and even death. And research does back this up.
The Centre for Disease Control has reported a 25 percent reduction in deaths for severely injured patients who receive care at a trauma centre compared to a non-trauma centre.
Having all of these highly-trained physicians and nurses on staff at all hours of the day and night ensures that, no matter the injury, a patient will be treated with the highest degree of care right away. What it comes down to is this: the quicker you get treated, the better your outcome will be. Top that with receiving the best and most specialized care available - and that's what makes a trauma centre so vital to all of us.
Apropos this and in the local context, extension of the existing PHCs into robust Emergency Rooms, fully equipped with trained manpower & modern equipment is a low hanging fruit that we should not waste any moment in picking up. We are fortunate enough to have a fully functional capacity building centre at Dhobiwan, Tangmarg for a recurring churn-out of trained professionals, be it medical or paramedical. I have my personal experience to back the statement that each of the trainers out there is a ‘beautiful mind’ in his or her own league. Besides there are institutions like SKIMS & GMCs which can also be roped in as the feeding agencies for upping the capacities of existing manpower. Not only would this aid in bringing down the unnecessary footfall in these institutions, therefore letting them focus on the academics and research aspect of the medical science, it would also evolve a situation where a trauma is transported in a much required, technically correct manner to the adequate level after scientific triaging and adequate level of pre-hospital care. Ranging from burns, shock, electrical injuries, falls from height, gunshot wounds, cardiac events, endocrinological crisis, et al, these ER’s and the professionals manning them should rise to be a force to reckon with for a community. To further compliment and bolster it all, placement of a Heli-Ambulance at each district headquarters would be all that we would need.
The forthright attitude of our doctors to do this and much more has over and over been demonstrated by them, be it managing the COVID crisis with sheer grit and indomitable courage or a less spoken about noble endeavour of ‘Save Heart Initiative’, which has enabled medical professionals in remote peripheries to save innumerable lives in the middle of a cardiac crisis. We are just ‘second to none’.
Dr Suneem Khan is a recipient of ‘President of India’s Uttam Jeevan Raksha Padak’ for the year 2017, for a lifesaving act.