As a capable researcher and a well-meaning doctor takes over the reins of SKIMS leadership, Masood Hussain reports that Dr Ashraf Ganai is facing a Himalayan challenge to revive a sick hospital
After remaining headless since March 2024, when Dr Parvez Koul superannuated, the Manoj Sinha administration has finally appointed noted endocrinologist, Dr Ashraf Gania as Director of SKIMS, the erstwhile best tertiary care hospital. An impressive researcher and a well-respected doctor, however, faces a Himalayan challenge in triggering a turnaround in a huge health facility that till 2018, was at the top of the healthcare pyramid in the erstwhile state.
Even though the hospital exhibited its capacity and will at the peak of Covid19, its cutting-edge status continued to nosedive post-pandemic. While part of the issues was the outcome of the chronic internal issues, the downslide, according to its staffers, was the result of its ‘fall from grace’ before the new managers of Jammu and Kashmir. A series of policy interventions, delay in the upgradation of the systems and lethargic approval of the proposals for taking the institute to the next level by the all-powerful bureaucracy are said to be the principal contributors in permitting the decay of a vibrant hospital, a deemed university with a medical college of its own.
Now, Dr Ganai is facing a challenge in his career in getting the hospital back on the rails. It is facing problems on all fronts.
Crippling Staff Issues
The hospital works with less than half of the staff at the sub-doctor support level. The hospital has been unable to fill the vacancies for many years. Earlier, it had a mechanism within the institution to hire talent, a facility that the government withdrew. Now the request goes through the maze of governance structure and lands in the office of the government’s recruitment agencies. The Jammu and Kashmir Subordinate Service Board (JKSSB) has its requirements for a “transparent” recruitment mechanism, which takes its own time.
The administration’s decision to strip the status of the Director, who was earlier enjoying a lot of authority, has added to the delayed decision-making in the institute. An added layer of administrative control has added to this crisis.
“You can not imagine that the ECGs in most of the SKIMS are done by daily wagers,” one insider said. “In laboratories, where more than 30 professionals worked, only three to four trained staff are managing the show.”
Another staffer said that earlier – apparently on the orders of the government, the management shifted more than 20 computer professionals to the Roads and Buildings department, leaving the teaching hospital in a state of mess. “All those professionals were fundamental to the systemic shift from manual to online and now we are facing serious hiccups,” one middle-rung officer said. “All those employees were recruited by the SKIMS and need to be recalled back to their duties for which they were hired.”
Outdated Machinery
At one point in time, the SKIMS was the major address for high-end investigations as its diagnostics set-up grew with technological advancement. That edge was lost in the last five years. Of the chain of CT and MRI machines, quite a few are operational. The latest addition in radiology was the installation of a used MRI machine that was supplied or donated by the DRDO, which ran a Covid19 hospital in the city outskirts.
“Our machines require upgrade because we have not been able to invest in this area for last many years,” one insider said. “While a few could be repaired and put to work, most of them need outright replacement as some of the technologies that we are using have been phased out by the routine hospitals across the country.”
There is a huge waiting list for patients supposed to be quickly diagnosed with certain life-threatening diseases. While a section of the patients who manage adequate resources go to the private sector or the SMHS hospital, a section that cannot afford it waits till death. Diagnostic investigations are not being covered by the Golden Cards as well.
In not-so-distant days, the hospital landed in a position in which it would refer its patients to SMHS or Super Speciality Hospital at Shireen Bagh for certain diagnostic interventions, especially in the Oncology.
It was in the midst of these issues that an all-party delegation visited Manoj Sinha and requested him to help SKIMS regain its status in the health management system of Jammu and Kashmir. Though a promise was made by the Lt Governor, the status quo ante was retained.
Accountability
Over the years, the staffers of the institute have been busy with two activities – professional rivalry at the higher level and passing the buck at the sub-doctor level. “We have a norm here that staffers mark their attendance and are lost in the hospital and when they are required, they need to be located,” one employee, who has worked in the hospital for more than two decades, said. “A section of the staff remains busy in locating doctors for their relatives and friends or the work they are not hired for.”
The employee said that unless the staffers are not made accountable, the patient care will not improve. Very recently, one hospital management staffer said, the Director during a routine visit recovered four prescriptions from a security guard.
The status of patient care is visible in the OPD where long queues can be found even in the late afternoon. There are very limited desks where the fees are accepted. Even the SKIMS staffers need a separate counter for managing appointments with the doctors for themselves and their families and for depositing the fees for availing different services. Interestingly, the computers on which the OPD operators work are obsolete and shut down every time the PDD switches the power supply off.
“Hospitals are usually supposed to get uninterrupted power,” one senior doctor said. “But our supply snaps at least twice to thrice a day.”
A pessimistic worker said the only hope that he has is the new Director visits the hospital personally and not relying on his subordinates. “I wish he visited every laboratory and checked if it is healthy,” the employee said. “The show is going on but that never means the stag is all right.”
Increased Load
While the hospital is seemingly fighting its own battle for survival, the commoners do not have an option other than SKIMS. The load is increasing. Owing to services, the patient-doctor tensions are increasing. In a recent case, at least two young doctors are facing an enquiry in an alleged medical negligence case.
The hospital is the first go-to address for treating the tourists and the Amarnath-bound pilgrims. Now the pilgrims facing issues on either side of the track land at SKIMS directly. This is happening because it is the main address for the health management of the people. So it must have a top priority at the bureaucracy level as well.
Director’s Take
Dr Gania has started dividing his time between the office, his clinic and in visiting the sprawling institute. “I am spending at least one hour in inspecting the hospital with my team and we locate the issue and decide on it on the spot,” he said. “There are issues, I admit, but the rumours that the SKIMS is on the verge of closure are incorrect.”
“I have taken over only last week. So, I think, I deserve some time to understand the issues and deficits,” he said. “Give me six months and then ask me whatever you wish.”
While he admits he has plans in mind, he is keeping cards up to his chest. It requires waiting to see how an endocrinologist fixes his hospital’s PCOS.
