Doc, Heal Thyself

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The health givers are messiahs in their own right because they help people to live longer, reduce their pain and contribute immensely to the societal well being. That was the key factor why people in all corners of the world saluted the medical staff as the pandemic unnerved humanity. The sector, however, has the flip side that it must treat on priority, writes Masood Hussain

An elderly person standing on a hilltop of Faqir Gujree area of Srinagar, praying to God for the end of Covid 19, which has engulfed the valley so badly and hundreds of people have been infected by this deadly virus so far. KL Image: Bilala Bahdur

In anticipation of the Covid-19 arrival, Kashmir was in a panic. When the first person tested positive – thank God, she survived, Lal Chowk got deserted in the first half of the day. In the subsequent days, the tensions revolved around the lack of personal protection equipment (PPE) for the medical staff, the testing facilities and how to tackle the patient load, if and when, the crisis moves to the streets post community transmission.

The response was phenomenal. Hundreds of women and tailors got into voluntary mask-making. The young students got into jugaad and created interesting tools to fight and manage the crisis. Communities at their own level started getting into fumigation-appliance making, created impressive tunnels, which they installed with their own savings. A young boy burnt his midnight oil to create face shields for doctors and then moved from hospital to hospital and distributed it among the medical staff.

A couple of entrepreneurs and the academics joined hands and devised a competition with a good prize (the government later associated itself with the initiative) for creating the tools that they thought would be helpful in fighting the pandemic better. Despite a lockdown in place since the summer of 2019, these young boys and girls created a variety of impressive tools to showcase – the ventilators, the robots and other things. What was the follow-up is a different story.

Finally came the intervention from Prime Minister Narendra Modi who rightly suggested tali bajao and thali bajao in deference to the frontline workers. This all was aimed at encouraging and re-spiriting the medical staff to face the challenge of an exceptional occupational hazard that every other professional face in their own careers.

GMC Srinagar

100 Days And Counting

More than 100 days later, when Jammu and Kashmir – like other places, is fighting the menace, the chinks in the armour are clearly visible. There is no survey but the fact is that the people suffering from routine illnesses die more in comparison to the pre-Covid-19 era. Of over six thousand Covid-19 positive cases, the deaths are still sub-100 and most of the cases, as doctors say, had co-morbidity issues. That is quite impressive a battle against the pandemic, so far.

Before we get into the ‘how’ and ‘why’ of the story, it is important to understand the crises that the pandemic-triggered-lockdown landed the society in. As the movement of the people froze, the transaction stopped and the earning nose-dived. Kashmir has five times more jobless people than it had by the end of July 2019. Those still on rolls in the private sector are getting merely a sort of subsistence allowance and not wages.

There is no sector that skipped the impact. Kids are restricted to their homes and schools are closed. Schools are expecting tuition fees but most of the parents sitting idle at home are not in a position to pay, at least, right now.

The only expenditure people are making is to ensure they have two low-cost, square meals, something that will not require seeks help or raising debt. The manufacturing sector is yet to reach even one-third of its capacity, even though they were the earliest to come out of the lockdown. The retail is almost locked. If it is not, it is just for the sake of dusting the properties. The purchasing capacity has gone phenomenally down.

The same chain of idleness is impacting the banks where the possibility of the accounts turning red is hugely high had not the Reserve Bank of India put a moratorium on the repayments for the six months, ending August 2020. How will the accrued interest play the game later is too early to be predicted?

The transporters have not been plying their vehicles since August 2019 barring a few months of semblance of normality, and then the Covid-19 forced them to restrict to their homes, again. The entire population that is linked to the transport sector is literally on the edge.

The handicrafts artisans faced the worst because of the communication lockdown in 2019. Well before they could move around and seek some work, their buyers were caught at different places across the world at airports and quarantine centres with their inventory locked for lack of buyers. They are not working at all, just spending time listening to the radio or watching the TV.

If somebody has to understand the impact of the crisis on the people working in informal and private sectors, they must talk to some of the volunteers working with various charities and non-governmental organisations who are on the ground for almost a year now. There have been a number of deaths lacking plausible explanations other than the depression triggered by the situation. Though it is too early to see the actual load of mental morbidity moving to the hospital, the early flocks are visible in the clinics of the psychiatrists and counsellors. Usually, most of the mental issues lead to physiological morbidity which is moving to the hospitals.

The Covid Collateral

Hospital Loads Surge

In situations like these, health is the first priority. In hospitals, they get sick when they find no takers for their problems. Kashmir lost a young journalist simply because the doctors stayed away from him first at the local hospital in north Kashmir and then in the SMHS hospital. His appendix had burst and the doctors were waiting for the Covid-19 test to come. It came negative hours after he had been lowered into his grave. Before dying, he told a fellow reporter: “if I die, hold this doctor responsible.” Who cares?

It is also a fact that a number of doctors and the paramedical staff were sent to quarantine – some actually were admitted for Covid-19. This all is part of the game. Thank God, we have not lost any medical professional to the pandemic so far. Rome created a milestone in such sacrifices and may God protect every other society from even chasing that.

But the Covid-19 had become a Himalayan alibi for the doctors in the established hospitals to avoid patients. Though only the cases of gynaecology are becoming news simply because of the emotional quotient that they carry, the fact is the number of people dying of treatable diseases is more. These cases can be traced in almost all small and major hospitals within and outside the city.

Under the existing protocol, hospitals are required to avoid elective surgeries as the Registrar and the Residents manage the show, as they do in the rest of the world. This is a pandemic special concession. But we all know that some of the veterans engage in similar surgeries in the private sector while avoiding the same in the hospitals they are employed with.

In such a situation, the people tend to visit the private hospitals in Srinagar or visit the doctors at their privately run clinics in mornings or evenings. Despite knowing the state of crisis that this society is facing these days, just ask around – how many doctors have made even a symbolic reduction in their fees?

Most of the doctors who are in private practice are already on the rolls of the government. They actually flaunt their status in the state-run health network to seek attention. If they could reduce their fees even by half or even start treating the patients free for the time being, it would somehow explain that this fraternity – the best in a classroom at twelfth level, is the best on all fronts. There are a few cases but not many. The argument that our own doctors are providing healthcare in the private sector at a very low cost in comparison to hospitals in Delhi and elsewhere is correct but that logic suits in normal circumstances. We are in a pandemic that first killed the economy.

Treating Virtually

Testing Diagnosis

Doctors are at the apex of the healthcare eco-system. But to be fair with them, they are not alone. There are other sub-sectors that earn even more than them for less capacity, investment and knowledge. A super-specialist, at least, has invested almost two decades in his studies, unlike an x-ray technician.

Diagnostics is a money guzzler and, if insiders are to be believed, they run the major show. In comparison to outside hospitals, the costs are still low but the tragedy is that diagnostic laboratories in Kashmir have not created a common minimum tariff. Ask doctors how much it costs to have an ultrasound?

A general perception within the medical fraternity is that even though the diagnosis is still cheaper in Kashmir, there is a possibility of making it more affordable. There is a requirement for a basic common tariff in this sub-sector. The players better put their heads together and create this structure without waiting for the government to intervene? They can create this while ensuring that they must earn honourably. Earning is not a crime but looting is.

Unmasked

Tablets of Titanium!

Pharmacy is not a small player. Conservative estimates put the industry at around Rs 1000 crore, mostly in Kashmir. Owing to the importance of the sector to the well being of humanity, it is an essential service. Barring that it is a roaring business. The margins for medicines are anywhere in between 30 to 80 per cent, insiders say.

Last week, an attendant of a patient said, the doctor prescribed injection and the hospital pharmacy said costs Rs 525 apiece. “I visited the Help Poor fair price shop and they said they lack the particular one in stock but it could cost less,” the attendant said. “I visited a shop outside and he gave it Rs 250. Later, the hospital pharmacy provided at Rs 225 only.”

Doctors say the crisis is huge in the life-saving drugs. “There is more than fifty per cent margin if the same drug is sourced from the wholesaler and even after that there is a margin of profit,” one doctor said.

Would the pharmacists in Kashmir get poorer had they started selling the drugs on minimum retailer prices and not the maximum of it. Ask individuals if they ever had any concession on a prescription purchase these days? Instead, at the outset of the pandemic, at least one pharmacist in Srinagar was arrested for selling a N95 mosque for Rs 350. (In panic, I have purchased four pieces from the same shopkeeper at Rs 250 apiece. Thank God, I did not use any of them so far.)

Worried Warriors

Mask, Rs 10

One of the major success stories of Kashmir in recent years was that we have successfully created an alternative chain of the hospitals in the private sector. They deserve credit for keeping these hospitals open in overwhelming situations.

Those who have been to these hospitals in recent days, just check, have they reduced the costs of their in-patient departments? They have restrictions on certain things because they source it from the market but they make bulk purchases. Why should a use and throw syringe cost Rs 10 especially when no hospital in Srinagar uses less than 1000 pieces a day? Why should a simple face mask cost Rs 10 when it is available in bulk in Srinagar at a much lower cost? They could still reduce the rate of the bed that the patient requires. For this, they are not dependent on anybody.

If all these hospitals have super-specialists sitting in the air-conditioned chambers, why cannot they have one doctor who will see the patients for simple and common ailments free? Are these hospitals shops? Do they owe anything to society other than investing in facilities with a better return on investment? The argument that they offer the facilities at much cheaper rates in comparison to Delhi or Mumbai is correct but bigger cities have bigger income sources. For the last two years, even the traditional economies of Kashmir have gone sick.

Childbirths In Pandemic

Pathetic Situation

All this is happening as part of the routine. Maybe all this would not have been written if everything was all right – people were busy in their routines, life was normal, people were earning and spending too. This society is literally on an economic ventilator since August 2019. The only section that is almost untouched are the people on the payrolls of the government. In more than 13-million population of Jammu and Kashmir, the employees of the government are barely a million, in fact, much less than that.

There is no doubt that the medical staff is treating the people. But the sector must spare some time to identify and treat the crisis within as well. After all, mutton sellers and health givers must offer some distinction. If they cannot, they comprise their own status.

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