Over 15 months have passed since hospitals in Jammu and Kashmir stopped seeing and admitting patients with complaints other than SARS-CoV2 infection. Only emergencies are an exception to this arrangement that affected the closure of OPDs, investigations and procedures for a majority of patients.
Today, around 5500 beds in J&K have been allocated and reserved for patients suffering from COVID19. Over 50 percent of these beds are occupied currently.
In Kashmir division, the number of admitted patients is nearly 1600. Roughly, if we put the bed capacity of SKIMS Soura and SMHS Hospital together, this is their strength, the two major hospitals in the tertiary care category. That leaves the entire bed capacity of all the other hospitals vacant. In Jammu division when this piece was written, the occupancy in hospital was just over 1400, again two major hospitals clubbed together.
However, 25 hospitals in J&K have been designated as COVID19 hospitals. In the level 3 category in Kashmir division, SKIMS Soura, SMHS Hospital, JLNM Hospital and SKIMS Medical College Hospital have been designated exclusive for COVID19. That means no general specialty hospital accessible for people with other ailments. Chest Diseases Hospital, as is expected, is also catering to only SARS-CoV2. Bone and Joint Hospital, which neither admits COVID19 patients, nor has lent any service to the management of this pandemic has also closed down its OPDs and elective surgeries as per J&K Government directions.
This may seem a very small percentage of occupancy and a very small number of total hospital bed strength available in J&K, but it translates into encroachment of every other service that was or could have been available to patients.
At least four district hospitals have allocated their major capacity to COVID19. Failure and reduction in this would mean that the patients from these districts would have nowhere to go given that the referrals have been made extremely stingy recently.
According to the last State-wise compilation of State-wise burden of diseases – Health of Nation’s States Report (2017), J&K was among the States with a concerning burden of various fatal diseases and conditions. As per the report, over 36 percent of people, across gender, lose life to cardiovascular diseases in J&K. High blood pressure, high fasting plasma glucose, high BMI, high total cholesterol and impaired kidney function feature among the top ten risk factors driving death and disability in J&K. In a decade, the proportion of population suffering from these ailments has increased drastically. While in 1990s, the report states, only 4.8 percent of population suffered from high blood pressure, at the time of the survey, it had doubled. High fasting glucose and high total cholesterol had more than doubled too.
In addition, J&K is among the top three states and UTs in India in terms of tobacco use and it has been responsible for an epidemic of various diseases and disorders including cancers and lung diseases. The detection of cancers in Kashmir had nearly doubled in five years. In March 2018, Indian Council of Medical Research had said in a report that around 22594 people died of cancer from 2014 to 2016 in J&K, which means 20 people lose battle to malignancy every day. Across board doctors believe that most cancers are detected in late stages in Kashmir, depleting chances of survival.
Those chances of survival are further depleted now. Since March 2020, access to healthcare has suffered a massive jolt. Although J&K Government announced that Cancer treatment would continue even during the pandemic, it is an unrealistic and misleading statement. A senior surgeon, when Greater Kashmir spoke to him said, “Cancers do not present to oncology department exclusively or straightaway. They are routed to oncology when a medical officer, a gynecologist, a physician, a gastroenterologist, a pulmonologist, a urologist or any other medical practitioner suspects, investigates and finds them,” he said.
The physician said over the past year, I have not seen or referred a patient with a tumor while as prior to the pandemic he alone used to flag at least around 7 every week while his colleagues at GMC Srinagar would see a similar number. He said these patients were picked routinely and never presented to hospitals as Cancer cases but usually as conditions as benign as stomach ache or headache. “Do you think these tumors have stopped inflicting human bodies now?” he asked adding that the number of malignancies getting delayed in detection could be imagined.
Similarly, hypertension, heart diseases, diabetes and other metabolic disorders, tuberculosis, kidney diseases and hundreds of other conditions which affect lakhs of people in J&K are being literally brushed under the carpet by the exclusive attention to the pandemic only.
And COVID19, as harsh as it may sound, is far from over and no end is in sight for quite some time now as far as the projections go. Healthcare system needs to evolve and devise strategies to ensure that a part of the hospital system is kept alive for patients who need treatment for serious conditions other than COVID19. Not all of these conditions qualify as emergencies as per the existing protocols.
No doubt COVID19 is an emergency and requires extensive and expansive healthcare facilities be allocated to it. However, other ailments continue to take lives unseen and un-talked about. These need a strategy for management.