Once again, the pandemic is set to turn the entire healthcare system of Kashmir into a COVID19 management ward. Hospital after hospital will close its doors to patients, to defer admissions and conserve human resource. Facility after facility will reserve a major chunk of beds for the anticipated load of severely sick that the growing number of COVID19 positive cases could bring about.
The pandemic has taken the healthcare systems as hostage, making other diseases and emergencies seem non-essential. When this piece was being written, 264 patients of COVID19 were admitted across hospitals of Kashmir division while the number of allocated beds was 1630 – 16 percent occupancy. The beds that have been earmarked for COVID19 treatment in Kashmir are mostly in tertiary care hospitals. Of the 1534 oxygen beds, 191 were occupied. Of the 96 ICU beds, 22 were occupied, 74 free.
The number of dedicated COVID19 beds has no changed much over the past year. In December, when the cases had dropped, and there were lesser number of patients admitted for COVID19, the empty beds were not reallocated to cater to requirements of patients suffering from other diseases. Therefore now, when the viral infection appears to be peaking in Kashmir, patients can expect to no reprieve at the facilities that they hoped could help them treat their ailments.
Out of the 16 hospitals that have been dedicated for COVID19 treatment in Kashmir, five are tertiary care facilities. Of the 1630 COVID19 beds, 796 are located in these tertiary care hospitals. Three of these super-specialty advanced hospitals are completely out of bounds for patients other than COVID19.
Last week, SKIMS Soura, the most advanced healthcare facility in Kashmir put a break on admissions, surgeries and procedures of “non-emergency” patients. A patient with chronic kidney disease, a patient with a growing tumor inside a vital organ, a patient with a weakening cardiac performance, a patient with diabetes raging the entire metabolism, a patient with lethal clots waiting to be located, a patient with lungs unable to sustain his activities will all qualify as non-emergency. These patients will need to wait till the pandemic is better, wait till a doctor is given the task to see them, till the diagnostic equipment is made available to them, till the ICU beds are freed of the “reserved” label, till the theatres are opened for them again.
Non-emergency does not translate into non-essential in healthcare systems. At 200 bedded JLNM Hospital for example, there are 17 specialties. However, for over one year, the hundreds of doctors, nurses, para-medics, technicians and other staff of the hospital have not seen any patient except the trickle of the COVID19 cases. During the peak of the pandemic, the hospital was used as a quarantine facility, housing families who were usually contacts of a positive case. Afterwards, when the new variants started emerging, the hospital was dedicated as an isolation facility for people testing positive and having history of travel to outside India. In the past few months, the daily admitted patient score has been ranging between zero to 30. The recent most reading of admissions was 24.
The SKIMS Medical College Hospital is AIIMS of sorts for people in its catchment area and in reality an advanced center for many specialties. The medical college hospital used to cater to thousands of patients with its pediatrics, maternity, orthopedic, dentistry, general medicine, ophthalmology and many other vital departments. The act of reducing the hospital as a two ICU bed and quarantine facility for COVID19 is criminal keeping in view how many patients depend on it every year, those who do not have resources to seek treatment elsewhere.
With this and other advanced, level 3 and 4 hospitals out of bounds, the year gone by made public sector healthcare inaccessible to patients. For many, it turned into a financial catastrophe as they were forced into seeking treatments and interventions in private hospitals. The year ahead, if no change is made at the policy level, could worsen the healthcare delivery in the UT, cut off from other states on economical travel routes, a significant part of the year.
A number of hospital buildings in Kashmir are ruining for want of use. The Trauma Centers, the new, yet to be inaugurated buildings, the old and abandoned buildings, the multiple buildings in a small radius, and many more could be explored by the health department as spaces for admitting patients, those who require observation for their symptoms of COVID19. At sub-district and district hospital level, beds could be allocated for COVID19. A year was an adequate time to ensure oxygen supply for a limited number of patients in these hospitals. It could still be done on fast track.
The COVID Care Centers, that had been made operational last year and that could again be made functional. There are ample opportunities, if the department decides to ensure healthcare for all, not just people infected with SARS-CoV2.
The Financial Commissioner Health and Medical Education, Atal Dulloo has been reiterating that healthcare needs to made accessible to all, not just COVID19 patients. However, at policy level, the hysteria triggered by rising cases has been taking the hospitals in the fire-fighting mode and one after other has started closing doors to other ailments.