‘Special’ – Already ailing State Health Services facing litmus test in Corona times

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Data by Government of India on May 24 this year. Photo used for indicative purpose only

By M L Verma 

Shimla, Jun 3

During the 2nd wave of Corona Pandemic state health Services are facing a litmus test to avert the number of causalities owing to Covid and non Covid diseases as the state was caught unprepared and the state of mismanagement has shown clear fault-lines in the covid health protocol.

The way people are losing their near and dears, and many of these with extent of sharp criticism, one could access the state of affairs. People after failing to get attention in hue and cry over the lack of proper healthcare are threatening to knock the door of Court by filing PILs against the state and department of Health. Chief Minister Jai Ram Thakur who is reviewing Covid pandemic on day to day basis himself accepted that a sizable number of Covid deaths have occurred in the Home isolation.

Number of fatalities has swelled up abnormally with an incline graph as state have lost as many as 3000 lives directly or indirectly in the pandemic in the state hospitals.

Many causality out of those, could have been averted if high priority had been fixed in time moreover Hospital staff who are doing special efforts did not have to risk their own health while treating the Covid patients .

No one denies that a lot of focus is being given to the fight against Covid Pandemic however people have volleys of complaints and serious aberrations of compromising the health protocols. Rather many citizens believe that even this chance to improvise the health systems is again perhaps being missed or to say the golden opportunity is going out of hand.

The state health institutions have well trained and experienced staff however the glaring gap in the health policy and unspecified SoPs in the hospitals could be responsible for the unending health vagaries. Even if upgrading of hospitals/PHCs was tight task now but the nation and state could have offered 24X7 tele–medicine services with up-gradation or revolutionizing of health communication technology. 

Failure of Health services under 3-tier health system

Centralization of state of art health services to the urban centers and dismantling the rural based improvement in the health services under three tier health system coined under flagship National Rural Health Mission created this complete chaotic situation.

NRHM avidly framed an ideal National Health system offering three tier Primary, Secondary and Tertiary health care in specially designated institutions. The public funds were being utilized in past many years to build up this robust health care system.

However U-turns of Govt(s) to mostly focus on the urban based health system gave birth to the mismanagement of health protocol. The state health policy is now victim of indecisiveness of the govt(s) to focus either on rural or urban centric health care. Mushrooming of private microbiology labs and road networks in the state health system currently is largely to the level of only Referral health center and Zonal units.  .

At the time of first and 2nd wave of Covid pandemic it was quite evident that state health institutions are facing shortage of staff. But what was available, like live saving technologies and infrastructure, even it was found lying underutilized or out of order. With availability augmentation of the infrastructure with new innovations (As needed now), the old machines and systems are being seen biting dust in pathetic conditions, stated some citizens.

Another casualty of the state healthcare is lack of proper clinical trail in primary health care system as pathological tracing of diseases is centralized to Secondary and Tertiary health care institutions. The patients who turn up in the Primary Health Center are being given prescription without clinical trail. This forces the people to rush to state premier health institutions and medical colleges which are meant for mainly high end tertiary care.

It seems that the old PHCs, CHCs are being converted into wellness center in a stereotype manner i.e  just having brick and motor health infrastructure. These Understaffed institutions,  in unhygienic conditions have just become show pieces of health care. Or else the Himachal Pradesh High court while hearing a PIL did not have to pass an order for the state Govt to fill the post of doctors in all the PHCs, or wherever lying vacant.

A medical representatives Seth Chand informed that heavy footfall of patients in OPDs of Secondary and Tertiary Health Center is responsible for lack of focus of State and Health Department on the Primary health care and mainly giving focus on referral hospital.

The fault-line in the health care system is leading to wasteful expenditure on the infrastructure and under utilization of existing trained staff, he stated. State Government accepted that only 400 plus doctors were available during Covid first wave at IGMC compared to over 700 available doctors, here.

The State of Himachal Pradesh are among the worst performing on doctor -patient ratio as it has one doctor to 3550 patients against the WHO guidelines of 1 to1000 doctors. The national doctor patient ratio of one is 1456.

Under NRHM policy for a referral there should compulsory deployment of five doctors including one  Gynecologist, surgeon, physician, radiologist and  anesthetist. Each Primary Heath center must have two posts of doctors. To not follow this policy with true spirits due to shortage of doctors made the rural health services a mess forcing people to rush to high end health care for even minor diseases .

Besides, poor counseling of patients or attendants is causing unsatisfactory situations during treatment as bee busy doctors could not be expected to provide counseling to patients.

Health priority for Covid treatment remained unrealized not following the WHO advisory in true spirit. The state health system and department were caught unprepared as it could not prioritize the quality health infra for Covid pandemic. The paucity of life support system like ICU, Ventilators and Oxygenated beds forced the court to intervene as the Covid death rate suddenly went up the above national level.

Rising of active cases and critical cases beyond the state health capacity not only forced people to search beds with proper health care in dire needs but it sometimes delayed owing to lack of facilities or victims taking casual approach to the severity.

Senior advocate of Himachal Pradesh High court Sanjeev Bhushan has been blamed the IGMC administration for negligence of health services as his sister-in-law died of Covid in the hospital. He said that department has informed him recently that an inquiry has been set up over these allegations.

He said that two PILs are pending in Himachal Pradesh High courts which have been moved on the courts own motion over lack of health facility.

Learned Counsel of HP high court Vandana Mishra said that state has accepted in its affidavit that it has 240 ventilators which could not be utilized.

The reign of quakes 

People are becoming victim of quakes as they are relying on the untested therapy of these quakes who are prescribing tips and tricks to people to avert corona and rely upon the various concoctions. Number of people with serious Influenza like illness are using Cow ghee to grease their nostril. Many of them are still relying upon lemons on the basis of a video clippings in which a saffron robed self style pathologists claimed it the complete remedy. Such tricks may lead to life threatening if victims could not be rushed to hospital in time.

People are relying upon non scientific remedies to get rid of the pandemic. The people are so obsessed with the idea of relying upon the non-allopathic remedy that numbers of them are buying the same from markets blindly. A person placed order for 15 kg ginger powder  to a grocery store had put even the shopkeeper in shock. Few days before a Bollywood Himachal based celebrity was heard equating the pandemic with common flu further widening the fault-lines in the society which could be treated with just awareness.

Writer is a senior journalist. The views expressed are personal.

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