Sher-I-Kashmir Institute of Medical Sciences (SKIMS) , was established as a tertiary care referral hospital for the treatment of serious medical ailments. Besides it was also envisaged that a super speciality hospital situated in the heart of Srinagar shall also promote medical tourism.
Over a period of time especially during the last over 25 years the peripheral medical support in the rural Kashmir has taken a big hit because of the reasons well known. This has resulted in huge rush for treatment at SKIMS for the ordinary medical support and has diluted the mandate of the SKIMS as the referral tertiary care hospital. One can not visualise from a distance the huge rush of the patients who report daily at skims Out Patient Department (OPD). Many a time the SKIMS administration has to put into service the security staff to regulate this rush and to avoid the stampede. The pressure on the SKIMS staff is so high that it shall be very humane to have a closer look on the quality and care available to the patients and continuous efforts on sustainable basis need to be made to improve the system, as the pressure on better and quality medical care shall increase with every passing day.
Some suggestions vis a vis present debate :
Doctors and scientists at SKIMS are required to provide the medical service to the refereed patients but also to do the research work for this geographically distinct area of the country which has its unique epidemiology of the diseases and causes. Besides the culture, weather and lifestyle also has its bearing on the diseases which are predominant in this part of the country, also need to be studied at this tertiary care medical Institution. Disease prevention is also a mandate of this tertiary medical centre. Doctors at SKIMS need a well balanced schedule of the engagement which include the patient care, treatment, research, library visits, trainings and finally some space for quite relaxing moments for refreshing.
Doctors at SKIMS shall have to see the referral patients only or at least for four days a week and for the remaining two days general patients can be seen. The number patients for a super specialist to be seen in the OPD must be limited to 20-25 patients a day, if the quality medical treatment has to be maintained. The number of the faculty and paramedical staff shall have to be complimentary to this formula and concept, keeping in view the patient record of last five years, which is readily available with skims medical record department.
With regard to the prescription under the law in vogue that doctors and para medical staff shall not undertake any private practice outside the premises of the SKIMS. The subject needs to be seen in perspective and not limited to the literal meaning of this legal prescription. This shall mean that within the SKIMS premises the specialist doctors can be made available to see the patients even in morning or during late evening hours in the campus clinics on a reasonable fee, which shall be partly shared between the specialist doctor and the skims. This concept of campus clinics has been debated earlier also long back, more so keeping in view the non existent quality medical facilities/infrastructure in the private sector, even when compared to a smaller city like Jammu. Delhi is far ahead in the infrastructure and availability of the doctors round the clock and perhaps that is the reason the AIIMS doctors do not practice outside their institution. This is a simple issue of the demand and supply. The campus clinics shall make use of the required infrastructural support to the doctors , which is available with highly trained paramedics and also could be further augmented. A ray of hope for unemployed youth can also be seen in this concept without any financial inputs from the Government, and it is bound to open up many pleasant opportunities /surprises.
The efforts have to be made for creating quick awareness amongst the masses for subscribing to the health insurance as that shall bring in affordability for taking the best medical treatment. In fact for sustaining the health care support, health insurance has become a driving factor. This shall perhaps encourage the private sector as well, as our medical entrepreneurs are waiting for this huge opportunity, this sector can unfold. There is an urgent need to draw out a policy focused to encourage the private sector as it shall go a long way to expand the scarce medical healthcare infrastructure across the state more so in Srinagar City , Anantnag and Sopore (to begin with).
(The author has served at SKIMS as Joint Director Admn/Chief of Materials Management , 1998-2001)