Delaying Emergencies

Kashmir’s roads and the situation send more people in trauma to the hospital than any other area in the region. But the hospitals lack a proper management of the emergency set-up that adds to the trauma of the injured and the attendant, reports Saima Bhat

Patient waiting in the que along with the attendant at SMHS hospital.

When gun fight rattled Shopian’s Sugan village, a bullet pierced the hip joint of Muhammad Altaf leaving him critically injured. Doctors at district hospital Kulgam referred the motionless patient to Srinagar with an advice that “any movement of his body while shifting can worsening his condition.”

At Srinagar’s Bone and Joint hospital, doctors suggested an X-ray and CT Scan before the treatment would start in Trauma Theatre, located on the third floor.

Given his condition, Altaf’s attendants found it very difficult to manage his investigations.

“Our doctors had strongly advised us against any movement,” Farhan, Altaf’s cousin said. “They said it could have damaged his dislocation of joint or spine. But here we rushed him on a trolley to reach an X-ray plant, 500 footsteps away from the emergency room and then to CT centre, on the second floor.”

After tests were done, Altaf was taken to the trauma ward. Doctors needed a clinical advice from the physician before they would go for the surgery. Kashmir lone orthopaedic hospital lacks a physician. It gets a physician for a round from SMHS hospital, who, normally comes after 1 pm for the round. “In case, a patient needs an urgent consultation then he is referred to the SMHS hospital,” an insider said.

Injuries apart, the trauma to the bullet hit was in his frequent movement from one place to another. “From ticket to investigations and the medicine, we had to manage it at different places ourselves,” Sajad, his attendant, said.

Hospital administration acknowledges the fact that all facilities needed for emergency and trauma patients should have not only been placed under one roof but very near to each other. They blame the hospital’s archaic architecture as the main reason and insist the building was declared unsafe by the fire and emergency department after 2014 floods. The World Bank has even released a particular amount for the reconstruction of the building but nothing has happened so far.

A declared trauma unit, the Bone and Joint Hospital lacks all the basics required for such a facility. A firearm injury received at Emergency is first resuscitated and then sent for an X-ray inside the main building or in the OPD. If in serious condition, he is directly shifted to the theatre.

Hospital managers said the new OPD block has come up, on modern lines where all facilities are available under one roof and adjacent to each other. “Only MRI machine is located outside the building, which we have got in a private-public partnership,” one of the managers said.

“We just provide 5ml syringes and fluid free of cost to the patients,” one hospital employee who spoke anonymously said. “Rest everything has to be purchased by the patients themselves.”

By a government order, it is mandatory for all hospitals to put every facility available in one emergency room but it has been implemented in only a few hospitals.

Hospitals seek a nominal cost for various diagnostic facilities. Even paying this amount is cumbersome, especially for patients who are in the serious state.

Sabiya had come to visit his cousin Irfan where she fell from the stairs. Shocked to see the state of his newly wedded cousin, Irfan without informing anybody took her to nearby Bone and Joint Hospital.

The ordeal, Irfan says started from the hunt for a wheelchair at the hospital gate. Finally, when he traced it, he was shocked when the man guarding it asked him to “deposit identity card” first. Not having his wallet along, Irfan rushed to his car where his cousin was writhing in pain. He rushed back, deposited the card and finally got the wheelchair.

In Emergency Ward finally, he was asked to get the emergency card first. Once he secured it, the doctor examined her and advised an X-ray. He went to pay the bill and was told to get the X-ray first. This facility operates from another building.

In the radiation-rich room, he accompanied his cousin and help her move. Once out, he went to collect the report but was asked to give the receipt of the bill. So he went back to foot the fill.

With the report in hand, he carried his cousin back to the emergency ward where she was diagnosed “with acute trauma” and not the fracture. The pain was persistent. She was advised to have an injection in the general ward. The prescribed injection was not available and he went to get it from the market. After a few hours, they were discharged. “It was tormenting,” Irfan said. “Patient had physical trauma, but I had mental trauma.”

In the emergency area of the SMHS hospital, one of the tertiary care hospitals in Kashmir, Shahzada, an 8-months pregnant, was accompanying her octogenarian mother-in-law, Mumtaz Begum and husband, Shabir Ahmad.

Mumtaz was too weak to walk and wanted a wheelchair. Shabir took his time and finally managed a chair and the admit card.

“We have a nuclear family so I had to accompany them to the hospital,” Mumtaz said. “We frequently visit this hospital because my mother-in-law is diabetic with heart ailments also. Most of the time goes in waiting in long queues.”

The hospital has shifted the super specialities of cardiology, neurology, neurosurgery, general OPD, endocrinology to the Super Specialty hospital building at Shireen Bagh. It is a serious exercise for the attendants to shift a critical patient from the main SMHS hospital to the new hospital, separated by a busy road.

Javid Shola, counter in-charge at SHMS, says they have separate counters for emergency patients and OPD. “We have a best administrative setup that is why we have least mortality rate,” Shola said. “We give facilities 24×7 and believe me every patient gets a turn in just 10 minutes if he waits for his turn in line.” But he accepts the patients do get infuriated which mostly result in verbal brawl if ‘influential’ patients jump the line. “We Kashmiris have high ego and if we have to wait in a queue in government hospitals we feel humiliated but the same patient will wait for hours together if they go in private clinics without creating any scene.”

Unlike Bone and Joint hospital, the facilities like theatre, USG, CT are placed under one roof in SMHS hospital. But all these machines are at different staircases, leading to the problems for sick patients.

“We are adding to our buildings every year just to make them more helpful for the patients,” Shola said. He believes service will improve if a patient had a lesser number of attendants along. “Our doctor’s maximum time goes waste in managing the rush. Have you ever seen 10 attendants on a hospital bed just for the gossip? And when patients give samples for blood tests, the attendants come every five minutes asking for the report..”

A hospital in South India charges Rs 50 from every visitor to a patient. Once, he is discharged, the amount paid by the visitors is adjusted against the bill.

Biker, Muhammad Anees, 18, met with an accident in Pattan. He was taken to the sub-district hospital where his cousin, Danish, was asked to deposit the fees for emergency investigations.

There, he found a long line waiting for a long time. He could only submit the fees when the treating doctor sent his aide for his help.

In the peripheral hospital, a doctor who talked anonymously, said small hospitals have clubbed facilities that trigger patient chaos. Emergency in every hospital must be a different unit, possibly in a separate structure, with facilities exclusively meant for the emergency patients.


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