India: GB Pant Hospital Crisis

Source: Greater Kashmir

When I was doing medical graduation the infant mortality in India was 60/1000/year live births and goal to achieve was 25/1000/year live births. Although infant mortality rate has declined to 47 (National family health survey 2005), mainly due survival of post neonatal infants that is between 29 days to 1 year. The fall was observed due to quality of services offered by health facilities and increase in availability of intensive care for newborn in these states.

The increased mortality in GB Pant Hospital is obviously because of govt. failure to keep health sector on priorities. Except in District Hospital Handwarah there is no neonatal intensive care unit in any district hospitals of Jammu and Kashmir as on date. Poor infrastructure, understaffed hospitals, obsolete equipment, and no modern gadgets have made it difficult to decrease infant mortality rate.  Neonates and infants are most fragile population among human beings. Many times it is very difficult for neonate to sustain extra uterine life because of many adverse physiological changes. For the sustenance these fragile neonates need ventilation for a while. But unfortunately we were having only three ventilators in the valley’s only children hospital out of which only two were functional. Hence a doctor can save only two infants at any point of time. Non availability of ventilators is not increasing only infant mortality but to morbidity also.

Post neonatal deaths can be decreased by implementation of many national programs like immunization, respiratory infection control program, diarrheal control program, IMNCI etc. but to decrease infant mortality rate the main focus should be on neonatal mortality, its causes, and preventive measures. The neonatal mortality can be decreased only when govt. takes initiatives to start neonatal care units in district and sub district hospitals, adequately trained manpower, modernization of labs with modern technologies and gadgets, protocol based neonatal resuscitation and transfer program in district hospitals, ambulances equipped with ambulatory ventilator and oxygen with trained staff to shift very sick babies to tertiary care hospitals is all that is going to decrease neonatal and infant mortality rates. This all needs political will and commitment.

We have a talent and skill but it is government’s responsibility to update our hospitals with modern equipments and gadgets. It is very unfortunate to mention that in 1950 the infant mortality in all developed and developing countries was more than 100/1000 live births/ year and has been reduced to less than 10/1000 live births in developed countries with India at 47/1000 live births / year; but Kashmir is missing the race.

The Doctors Association demand two state of the art hospitals in north and south Kashmir with all specialist facilities, manpower, equipment so that referrals from their respective district hospitals is managed there. These hospitals should be at par with tertiary care hospitals and deal only with treating referred patients. This will automatically decrease burden in tertiary care hospitals. But contradictory to our thoughts our tertiary centers are like district hospitals and district hospitals not more than dispensaries.

The recently framed health policies are proving adverse to state health system. Newly framed transfer policy is draining talented doctors out of valley and mandatory 2 year peripheral service is creating a vacuum in central hospitals. Before creating any health policy govt. should consult experienced health experts. As per new health transfer policy newly appointed doctors are to be posted in inaccessible zones for two years and then for 5 years in difficult zone. This has led to many young talented doctors leaving the state. Doctors Association has right from the beginning an agenda that posting of doctors should be done as per their state subject addresses so that category benefited doctors serve their own community. Paradoxically the category benefited doctors are posted in cities as they have clout and general category doctors are posted in far flung areas. After 6 months six registrars in GB Pant will complete their tenure. As per this policy new recruitment of registrars is very difficult, which will land GB Pant into shambles.

At last people have to accept the fact that infant mortality is part of the game. Many neonates are born prematurely, many with congenital malformations and in born error of metabolism, were death is inevitable. But there is scope in our field to decrease it to lowest possible level if govt. upgrades our sector with human resource and modern equipment.