Critically Missing

With Kashmir’s highways sans emergency services one has to travel around 70 kilometres to avail critical care in case of an accident. Suhail A Shah reports the ordeal of patients in need of quick fix  

Qazi-Gund-HospitalThey Shooed people away with part cries and part wails. The family of this young man, apparently in his early twenties, carried him on a stretcher through the narrow corridors of, Islamabad district hospital, south Kashmir’s biggest critical care hospital. He was all blood, had just met an accident on the Highway. His mother ran alongside the stretcher, wailing as her son lay motionless. Another young man probably his brother, wheeling the stretcher with all his might.

The look of relief on their face imminent, as the stretcher was finally wheeled into the casualty.  The mother sat in the corridor, relieved to reach the hospital and anxious, worried over the fate of her son.

However, not more than 5 minutes later, their ordeal starts afresh. The running, wails, screeching of the stretcher resumes.

“The injured has been referred to Srinagar without even receiving the basic first aid.” the onlookers shrugged their heads in dismay.

 The family was on its own again!

Don’t know what happened to the boy but dozens of people every year die reaching Srinagar for critical care treatment for the hospitals in rural areas continue to be ill equipped on machinery as well as man-power.

It would have taken the boy more than two hours to reach the SK Institute of Medical Sciences in Srinagar, the only place in Kashmir that has Neurosurgery available, which by any stretch is quite a while for the grievously injured.

On April 6, 2015 Chief Minister (CM), Mufti Sayeed, in a written reply to a question by member Yasir Reshi in legislative Council informed that in 2014, 257 people were killed in Kashmir valley in road accidents.

As many as 2560 people were injured, many of them very critically, in 1794 mishaps that took place in the year 2014.

This is not something new, however. The CM also produced a figure for deaths caused in road accidents in last three years and the figure is massive, 892, in 6067 accidents.

Most of these accidents take place on the Srinagar-Jammu National Highway if not all of them.

The Qazigund-Banihal stretch of the National Highway has a history of being a treacherous path and accidents are frequent along it.

Keeping these accidents and the fatalities caused in mind, the government in 1997 took a noble step and sanctioned the construction of Trauma and Emergency Hospital’s in Banihal, Qazigund and Kangan.

The aim was to provide critical care to the patients, who otherwise lost their lives reaching Srinagar.

18 years down the line and with all these three hospitals functional, the patients still strive to reach Srinagar in time.

A Trauma hospital without a blood bank, a critical care ambulance, CT-Scan equipment or a Neurosurgeon is hard to imagine.

The foundation stone of Emergency and Trauma Hospital at Qazigund was laid by senior National Conference (NC) leader and then Health Minister, Dr Mustafa Kamal, in 1997.

The hospital got finally functional in 2010. The thirteen year wait however proved not worthwhile.

The Hospital continues to be a stark reminder of the grim Health scenario and the most importantly government empathy towards the sector.

Soon after the hospital got functional the administration wrote to the government for sanctioning of a Blood Bank, which ironically is yet to be sanctioned.

“The Blood Banks need a sanction from central government and they have been sitting on it since the commencement of the hospital.” a senior official from hospital administration told Kashmir Life, on condition of anonymity.

He said that the hospital, out of its own funds, has managed to put up a small blood storage unit but for most of the cases they have to send people running to either district hospital Kulgam or district hospital Islamabad for blood.

“Both the district hospitals are at least 10 t0 15 Kilometres away from here.” the official said.

As a result the hospital has turned into yet another ‘referral’ hospital.

A doctor at the hospital says its painful to refer grievously injured without even, “tending to their wounds.”

“We are helpless however. We want to save their time, which we know is more than precious,” the doctor says, recalling a particular trauma case from along the National Highway.

“He was a young boy. I remember his name was Javaid. We could have saved him if only we had the most basic equipments here.” he said.

The doctor says that the boy had abdomen injuries and despite being ‘comparatively treatable’, he died on the way to Srinagar.

“They got stuck in the traffic jam at Batengoo in Islamabad and he died there because of excessive blood loss. It’s not that we do not want to treat patients but we are not equipped enough,” said the doctor.

Like in this particular case, the doctor said, the boy needed blood and we had to get it from Kulgam, “the risk of waiting would not have been worthwhile, any which way.”

Over the period of time this Emergency hospital has been reduced to a community Health Centre where the administration takes pride and flaunts the number of deliveries they have administered within a particular period of time.

Presently the hospital has only one surgeon who divides his week between the hospital and another hospital in Rainawari, Srinagar.

Apart from the Surgeon the hospital has an Ear, Nose and Throat (ENT) specialist and a Medical Officer who also doubles up as an Orthopaedic Surgeon, having a Masters degree in the stream.

“It’s not the lack of equipment that keeps us from performing critical surgeries here. It’s the lack of staff that harms us,” the senior official in hospital administration told Kashmir Life.

He said that if doctors are at disposal the hospital can look for ways and means to make them work, “We cannot make them sit idle.”

Recently, the hospital administration has written their requirements to the government in an effort to make the hospital whatever it was meant to be.

And if the hospital authorities are to be believed they need at least 17 doctors including two Neuro-Surgeons, six general surgeons, two physicians and a couple of gynaecologists.

“You see without these doctors we cannot function as a Trauma hospital,” the official, who remains posted at the hospital since its inception, said.

Moreover, the hospital administration has asked for a CT scan machine, a digital X-Ray machine, a Blood Bank, Ventilators for the Intensive Care Unit (ICU) among other machinery.

Which essentially means that the hospital is functioning without these facilities and a simple accident case which otherwise could have been treated in time can become fatal.

The Trauma hospital at Banihal is no better either.

“They refer their patients to us and we refer them to Islamabad district hospital or Srinagar, depending on their condition,” a doctor posted at the hospital said, adding that in most of the accident cases the patients need a Neuro-Surgery which remains available only in SKIMS.

From here starts the real ordeal for the Trauma patients. In absence of a critical care ambulance the patient is ferried in an old vehicle, painted white and red, with only a stretcher inside.

“The condition of the road makes the chances of survival even more bleak,” says the doctor.

While some take their patients straightaway to Srinagar without wasting much time, others are not that lucky for they get referred to Islamabad district hospital and lose precious time reaching there and then to Srinagar.

Islamabad district hospital holds the distinction of being the biggest in south Kashmir region. However the critical, Trauma, patients get no better than a ‘referral’.

The story remains same. The hospital is short of doctors and short of the necessary equipment to treat such patients.

“Even though we do have a CT Scan equipment here it remains defunct most of the times and even if it’s working we do not have a dedicated specialist to handle the machine,” a doctor at the hospital revealed, adding that the Operation Theatre is also not equipped enough.

The doctor says that they work in extreme conditions, “can you imagine a power blackout in the middle of a surgery? Things continue to remain pathetic and in such scenario we prefer to refer patients rather than risking their lives.”

Adding to the patient’s woes the long, frequent and messy traffic jams diminish chances of survival; if at all any are left after so many referrals.

A senior journalist, who has covered south Kashmir extensively, says that in mass agitations of 2008 and 2010, against the Indian rule, many young men injured in police firing lost their lives for the simple reason, “that they couldn’t reach Srinagar in time after being referred from here.”

It was June 29, 2010 when 17 year old Shujaatul Islam was shot at by police in Anchidora area of Islamabad town, along with two other teenagers.

While the other two died on spot, Islam was lucky to make it to the district hospital but not lucky enough to live.

“It was the usual story. He was referred to Srinagar and died near about at Awantipora, some 25 Kilometres from here,” the journalist said.

Anantnag-Awantipora stretch, minus the traffic mess, takes at least 25 minutes, which means Islam had a window of about 35-40 minutes including the time at the hospital.

Despite this large a window he could not be saved.

The doctor at Islamabad district hospital says that they had floated an idea with the state government which was to rent helicopters from Army, presently occupying the High Ground area of Islamabad town.

“If the government were serious in saving lives the idea would have been implemented by now and many a precious lives saved,” said the doctor.

Instead the government laid another foundation stone, this time in Bijbehara.

Land has been acquired in 2011 to construct another Trauma hospital in the south Kashmir town, along the National Highway.

What remains to be seen is the time that will be taken to construct the hospital and the facilities provided there, if at all the hospital is constructed.

Till then stay safe and pray not to be a part of a mishap.

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