District hospitals without adequate oxygen supply, resort to referrals

Attendants of patients wait for oxygen cylinders at SMHS

In absence of adequate oxygen supply and trained staff in the district hospitals of Kashmir, the tertiary care facilities in Srinagar are struggling to keep coronavirus-infected breathing.

“We are getting patients who could otherwise be managed at peripheral hospitals,” a doctor at Chest Disease Hospital, Srinagar said.

He said the hospital was already running short of beds, and unnecessary referrals were further complicating the things.

A doctor at SMHS Hospital suggested that only those patients who are in need of very high oxygen requirement and ventilation should be referred to the hospital.

“Around 50 percent of the burden on tertiary care hospitals will ease if patients requiring normal oxygen supply or even slightly higher are managed at peripheral hospitals,” he said. A doctor at SKIMS said that the second wave of COVID-19 was yet to peak and the doctors in tertiary care hospitals were already finding it difficult to keep patients breathing in absence of oxygen supply beds. Shopian district hospital in south Kashmir is still without an oxygen plant. “We have six oxygen concentrators at our disposal but don’t have high-flow oxygen facility,” Medical Superintendent (MS) of District Hospital Shopian, Dr Muhamad Ismail said.

A medic said the respiratory ailment and pneumonia patients were at times being managed by concentrators but preferably referred to other facilities and Srinagar hospitals for want of oxygen supply. “The hospital these days does not admit COVID-19 patients at all,” he said. In District Hospital Kulgam, the plant set up six years back was made operational only a few months ago. However, it has inadequate oxygen points and a capacity of only 350 liters per minute (Lpm). “The oxygen supply is not sufficient and patients needing slightly higher flow are referred to Srinagar hospitals,” a medic said.

Medical Superintendent (MS) of District Hospital Kulgam, Dr Muzafar Zargar said that they have sufficient number of beds with oxygen supply.

“Within a week, we will get 1000 Lpm capacity high-flow oxygen supply,” he said.

Another doctor said that as the plant remained non-functional for five years, the hospital administration did not shift medical wards, surgical wards, casualty and other wards to the new building inaugurated a decade ago. However, Zargar said that the new building had now been specifically designated for COVID-19. The scenario in district hospital Pulwama is no different. “There are inadequate oxygen supply beds that too of low capacity. So, most of the people requiring respiratory support are directly referred to Srinagar hospitals,” a medic said.

In the 250-bedded GMC Anantnag Hospital, doctors said only 30 beds had high-flow (350 Lpm) oxygen supplying points and 20 normal flow.

“There is no high flow oxygen supply even in the 20 bedded isolation ward of the hospitalcrammed in an old building,” a medic said. “The COVID-19 positive patients have to rely on manifold supply cylinders.”

He suggested that the isolation wards be shifted to medicine wards again and already available oxygen points there be augmented. “As the patient rush increases, the pneumonia patients have to wait for hours together to get the much-needed oxygen supply,” the medic said. Medical Superintendent (MS), GMC Anantnag Dr Iqbal said the plant is being augmented to 1000 Lpm.

“The process to install two more high-flow oxygen plants (1000 Lpm) is on,” he said. Dr Iqbal said that the hospital also has more than 100 bulk oxygen concentrators at its disposal.

A health official said the hospitals had failed to hire the trained manpower to run the oxygen plants (low, normal and high flow) even a year after the outbreak of pandemic.

“Augmenting high flow oxygen supply in hospitals will help reduce the mortality rate due to COVID-19 virus,” the doctors said.