Last week, denial of admission to a pregnant woman in Lal Ded hospital, and subsequent death of her newborn on roadside in summer capital of Srinagar, created uproar in Kashmir. While a committee set up to probe the heart-wrenching incident is yet to come up with its report, the tragedy that befell the family has once again brought focus on status of maternal health services in Kashmir. According to official data, on an average 32 expecting mothers are referred to Lal Ded from different hospitals across Kashmir each day. Being a tertiary-care hospital, referrals constitute bulk of patient load there. However, statistics reveal that at least one out of every three cases referred to Lal Ded could be handled in peripheral hospitals. In other words, after evaluation of condition and history of patients, around 33 percent of referrals to the hospital have been labeled “unjustified”. From 01 January to 21 January, at least 621 patients were referred to Lal Ded from all districts. Of these patients, a panel of doctors that scrutinizes medical records and history of patients categorised 212 referrals (34 %) as unjustified. This chunk of patients, officials and doctors at the hospital said, puts an “extra and unnecessary burden” on manpower as well as facilities at the city Hospital. Among all districts, highest number of patients is referred from Kupwara. The cases vary between 14 to 20 percent every month. This district which constitutes a little over 12 percent of population of Kashmir division, has one of the highest number of “unjustified referrals” too, data reveals. The neighboring district of Baramulla presents similar picture. Equipped with a 300-bedded district hospital and being augmented with a medical college, the district contributes around 15 percent referrals. In December 2018, out of total 766 patients received by Lal Ded hospital as referred cases, 115 had been sent from different health facilities from Baramulla. An official at LD Hospital said Baramulla hospital could have served as a nodal point for maternity services for entire north Kashmir rather than sending patients to Srinagar, had the hospital been equipped with necessary manpower and infrastructure.
However, officials in the districts counter the argument of unjustified referrals. Dr Bashir Ahmed, chief medical officer Baramulla said that in a year, over 19000 deliveries are carried out across health centers of the district. “It is expected that around 10 percent of cases would need referral to tertiary care facility,” he said, while stating that the annual share of referral to LD Hospital from Baramulla was less than 2000 patients. “It is totally justified,” he argued. In Kupwara, the gross shortage of staff at the hospital to cater to the patients’ load has been a long pending issue. While on one hand, the hospital was accorded district hospital status more than a decade ago, it still awaits sanctioning of required infrastructure and manpower. While the district has seven community health centers and highest number of sub-centers among all districts of Kashmir, the scattered manpower in these health facilities has made it difficult for administrators to designate any of them as a 24×7 maternity center. A health administrator working in the district, while citing load of delivery cases, both normal and surgical, said that every referral from the district is “justified”. “It is not fair to call a referral unjustified while applying the criteria that are contradictory to ground situation,” he said. Giving an example he said while in December 2018, 150 maternity cases were referred to Lal Ded, at the same time, 652 deliveries were carried out in the district health facilities, with 137 of them being caesarean sections. He added that the figure was among the highest across districts. “In Budgam, which has a higher number of CHCs and a better maternity staff position, there is less than half of work done in terms of maternity services,” he said. Official figures reveal that Budgam district health services carried out 226 deliveries in December 2018, 88 of them were surgical in nature. In addition, the district referred 105 cases to LD Hospital same month. Medicos feel that case of Kupwara woman Surraya Begum, who lost her baby and underwent a painful experience, was a grim reminder of where planning and management of maternity service has gone wrong in Kashmir. “The Government and administrators of healthcare system take refuge in numbers, cite the increase in number of beds and increase in institutional deliveries as an achievement,” a senior official in health and medical education department said. “But these figures do not reflect the horrible experience Suraya Begum went through. She was shuttled from a health center to a district hospital to Srinagar before she met the tragedy. That is where the failures lie and it is for policy makers to ponder upon.”