Kashmir Healthcare

Murder of Kashmir’s Healthcare System – II

Dr. Sadaf Munshi

About a year and a half ago, in August 2013, I was in Srinagar for another yearly visit to Kashmir. During one of those days, an unidentifiable insect bit my mother-in-law in her eye-lid. We thought it was a spider or something but could not say for sure. At night, she had an allergic reaction and was taken to SHMS hospital. Situated in the heart of the city and built in 1948, the Sri Maharaj Hari Singh hospital is perhaps the oldest hospital in the city. With such a long history, one would expect it to have evolved into one of the finest healthcare facilities of the state. Unfortunately, that is far from reality. It turned out that my mother-in-law was grounded in the hospital for about ten days without respite; this besides the number of months it took her to fully recover from the incident and after effects which almost took her eyesight.

I visited the hospital several times before my mother-in-law was checked out, still in pretty bad condition. What I saw in the hospital was not unusual but nothing one would call “normal”. You will find patient wards flooded with visitors round the clock, as if it were a festival of sorts. Except for a few threatening gestures to newcomers, there is hardly anyone checking at the entrance gate. It wasn’t clear if there were any rules or regulations regarding visitor presence, and if there were, they were ruthlessly violated. Like a busy railway station, people were brushing each other’s shoulders in corridors and walkways all the time.

At several occasions, my mother-in-law had to be shifted from Dermatology to a different ward for oxygen. The concerned ward did not have any, and the area meant for the purpose was persistently locked. Because there was no BP machine either, the medical staff on duty relied on the neighboring ward to borrow theirs while patients waited for hours. It was quite an ordeal. “Why don’t you have your own machine in the ward?”, I asked. A staff member responded: “It was stolen a few months ago; so we have had to borrow from the other ward”. “But how much does the machine cost? Why can’t you get your own?” I asked. “It doesn’t cost much, but we need to have the orders and the paperwork approved. It takes time for that. It is a lengthy process”.

Since my mother-in-law’s face and neck had been badly swollen, she needed regular ice packs. But the hospital did not have a functioning refrigerator. We were asked to bring our own, just like the medications. “But this is not something that can be brought from home”, I protested. “You need to have a refrigerator right here”. Our pleas fell to deaf ears. Somehow, we managed a couple packs but these would melt soon. So, every few minutes we had to run to the canteen wallah in the next building, “Could you please keep this in your fridge for some time? They don’t have a fridge in the hospital”. The man obliged. But because of prolonged stay, it was overly embarrassing to continue to ask the guy for the favor. Therefore, we asked visitors to bring ice from home. A lot of ice came in thermos flasks, lunch boxes, and so forth, sometimes all at once, but sometimes none. But when we got it, the damn thing would melt within minutes. Considering the amount of effort it took in arranging such a basic thing like ice, frustration levels were very high.

After a few days, my mother-in-law was still unable to open her eye. So we had to take her to Ophthalmology for a checkup. With droves of people waiting, there was little hope that a doctor would see us anytime soon. People kept cutting into the line, and we had no sufarish. Exhausted, she turned to me sheepishly: karsi English paeth kath, balaay hay lagay. Sakh dag hay chhem (‘Talk to him in English, I beg you. I am in immense pain’). After a little hesitation, I opened the door, “May I come in?” Voila! A few words in good English can work wonders in such a situation. To hell with ethics!

With little improvement in her condition, it seemed the medicines were not working. The hygienic conditions of the hospital were so repulsive we wanted to leave as quickly as possible. Cats and dogs were roaming in the premises and rodents running underneath patient beds. With the sweepers’ half-hearted strokes besides tarnished ground and bloodied toilets, the floor was stinking. Heaps of construction materials and loose cement in the corridors led to dusty stairways. Garbage bins had turned filthy dark with liquids spilt on their surface over time. The sight and the smell were so repugnant that even a healthy person would nauseate. The heavy traffic of visitors was only adding to all this. I wanted to see the superintendent but she was nowhere to be seen. “She will come at 2:00pm”, said someone. “After she is done her private clinic”, a patient added mischievously.

During one of these visits I found a lady on the next bed missing. “They took her to emergency. I wonder if the medications are working….”, somebody said regretfully. I had seen her doing well only a day before. Suddenly we heard a group of women screaming, thumping their chests and wailing at the death of a loved one; this was probably the third one in a row past three days in the hallway. A severely injured young man barged into our ward asking for help. A man – a doctor or an assistant or a patient, no one could tell – pulled the bandage from his wound on the spot, mercilessly, while standing in the middle of the ward, exposing an open gash. It was a horrendous scene. Patients and attendants gasped. I covered my eyes in disgust: “Why here?” It felt like a slaughterhouse.

Every now and then mother-in-law needed oxygen, which meant having to take her over to the other ward. But often no staff or nurse was seen around. And even if there were, it was challenging to identify and find them. Few wore a uniform and no one had a badge on them. Offices were mostly deserted, except for few brief occasional appearances. We were clueless as to what to do in need. At one of these occasions, I wanted to speak to a doctor or a nurse, but it was not clear who was in charge or where to find them. The notice board on the wall was clean, with no updates at all. Eventually a young lady in a bright colored shalwar-qameez came in with a file in her hand accompanied by a couple more people, apparently to examine her. Perhaps she was a nurse or a doctor, or whatever. I asked her name and designation. She got offended and asked why I wanted to know that. I said, “Just for records”. Angered, she turned to me: “Why do you need that?” I said we needed to know so that we could check her status or inform the doctor of any complications if need be. Besides, we had a right to know who was treating (or not treating) her.

The young lady, perhaps a resident trainee, now very upset, scoffed at me. The matter ended up in a bitter confrontation with her refusing to disclose who she was. Frustrated, I took a picture of her. In response, she grabbed my phone and ran away. I tried to follow her but she was able to beat me and vanished into the ocean of people. Consequently, I went looking for the Superintendent. After a bit of running around, I found her in her office. When I explained the situation, the officer turned to me, “She is a young unmarried girl. You took her picture. That was not right”. “Oh? And what you and your staff are doing here all the time is very nice?” After a bit of argumentation, the officer toned down and brought the young lady in. I got my phone back after deleting her picture. But I never got to know her name nor her designation. I hated that.

As I saw my mother-in-law in the ward afterwards, finding me still fuming at the entire ordeal, she pleaded: balaay hay lagay, tsa gatshtay garay; yim hay tshinanam maerith (‘I beg you, please be go home; they will kill me’). With no other venue to go to, she was afraid she might have to pay for the consequences of my behavior. Like anyone else would do in such a situation, I did the same. I left.

 

*****

First published in Rising Kashmir, Feb. 2015: http://www.risingkashmir.com/murderer-of-kashmirs-healthcare-system-ii/

 

Murder of Kashmir’s Healthcare System – I

It was summer 2007. I was in Kashmir with my two-year old son. I had decided to get his khatanhaal (‘circumcision’) done in Srinagar (and not in the United States) due to some scheduling issues and the nervousness of dealing with any aftercare on my own, this being my first child. As I had little time for or faith in the government hospitals of Kashmir, I thought I will get the procedure done in a private facility. Somebody recommended a doctor who ran a private clinic at Buchpora. I visited the doctor. The clinic was situated in a corner of a beautiful garden next to a majestic house. It was a dusty, dingy clinic, with marks of blood on the bed sheet spread over the bed on which my son was asked to lie down. I asked the doctor to change the bedding. A hoard of patients was waiting outside, some of them for his gynecologist wife in the room next-door, while a couple pharmacists kept pouring in now and then. The doctor suggested I should bring the child to Shaikh-ul-Alam Hospital, a private medical facility at Karan Nagar.

We went to the hospital on the scheduled date. When the procedure was done, we were shifted to a patient care room on the first floor. Soon afterwards, a sweeper lady came, waiting on us to leave. “But he just had the procedure. We have paid for one night. Why are you in such a hurry?” I protested. “We have to bring another patient”, she said. “How can you bring another patient when the room is reserved for us until tomorrow? We are not moving until I feel we are ready to go”, I added angrily. With utter disregard, the lady left and came back barging into the bathroom with a huge load of laundry. “You cannot do that until we are here”, I said. She ignored me and continued to do her laundry. After she was done, I needed to use the bathroom. As soon as I stepped in, I slipped and tripped over the soapy water that the woman had spilt all over the bathroom floor, hurting myself. Annoyed at this, after a bit of grudging and grumping, we decided to leave the hospital.

I went downstairs to the reception to get the release, requesting documentation for the procedure and for my payment. We got a receipt for Rs. 500 but no other documentation. I looked at it and turned to the guy at the window: “We paid three thousand rupees for the procedure. What is this? And I need documentation with the name of the doctor who conducted my son’s surgery.” The man seemed to be in a dilemma. After a bit of back-n-forth argumentation and messages being sent across to the hospital Director, I was given some documentation but with the name of a different doctor. “I need the name of the right doctor, and I need a receipt for the complete amount ”, I protested. The young man, apparently under obligation to follow a certain protocol, pronounced: “Madam, go and talk to the Director. Why are you yelling at me?”

I asked for the Director’s room and was shown upstairs. My father and uncle were waiting outside impatiently, as my mother held the poor boy in her lap, with all the bandages on his little thing. As I went in the Director’s room, I found the man sitting amidst a bunch of people, perhaps his employees. Quickly, he exploded from his high chair in his sleek western outfit donning an impressive necktie: Tse kath peth chuth shoar lougmut? (‘Why are you making such noise?’). I tried to explain, but who would care to listen to a lowly creature of a young woman dressed in a cheap shalwar-kameez with no signs to signal the standards of my socioeconomic status. In another spurt of disgust, the man threatened me with: tse chey na patah ba kus chus, mye kyah qualification che. (‘Do you not know who I am, and what my qualifications are?’). This arrogance of his, despite being at fault, further infuriated me and I retorted in an equally belligerent tone: Mye che na patah tse kyah qualification chey, magar mye chukh baasaan anpadh sindi khota badtar (‘I don’t know what your qualifications are but to me you are worse than an illiterate’).

It turned out that the concerned doctor who had done the procedure on my son was the head of the Department of Pediatrics at Sher-e-Kashmir Institute of Medical Sciences (SKIMS). ‘Didn’t you know that they are not allowed to indulge in private practice? Why didn’t you figure out before coming here? Why didn’t you go elsewhere?’ he tried to reason with me. “So, it is my fault and my responsibility to do the investigation, and not yours who is allowing illegal practice in your facility? I will make sure you pay the price for this malpractice”, I blurted out, now in English, warning that I would take him to court.

Uhuh! Figuring that his rants were rendered ineffective, the man was considerably deflated, intimidated by a mere foreign language. Nervous, he picked up his phone and called the concerned doctor. In the next half-an-hour or so, both men tried to pacify me, pleading that I “keep quiet”. Keep quiet in more than one way, that is. The Director even tried to bribe me, offering to return my money “in full”. I threw the Rs. 1000 notes as well as the fake documentation they had just prepared for me at the table and banged the door behind me to leave. By this time my father and uncle had come in to put the situation in control while the Director was trying to negotiate with them. On the way home, the duo tried to explain to me how it was a “common practice in Kashmir. The whole system is like that. You are here for only a few days. Just leave the poor guy alone; he will lose his job”.

Leave the poor guy! And so I did. For the next few days, the doctor kept calling me on my phone, trying to make sure that I did not expose him. “I will get you all the documentation you may need, but please do not make a hue-and-cry about this. I beg you. I will loose my job and my reputation”. Under severe pressure from various people I gave in and let go.

A few days later, I was at a wedding; my brother’s friend was getting married. As I was waiting in the living room of the brother’s friend’s house, I caught sight of the doctor. His wife, in a light pink satin “suit” and a beautiful pearl necklace adorning her neck, accompanied him. As soon as he saw me, the doctor smiled hesitantly, passed a greeting, and introduced his wife; perhaps embarrassed, or worried, or grateful, I don’t know. I responded with half a smile. Later, in the “tent” for the womenfolk, when we were about to have our dinner, I found myself sitting next to the wife. As we were still waiting to be served, her cellphone rang. She picked up the phone to answer the call. I overheard her talking to someone about what appeared to be a medical emergency. From the nervousness reflected on her reddened face and her broken vocabulary it seemed that a gynecological procedure that she had carried out that day had most likely failed. The problem wasn’t the failure of the procedure itself, but the fact that it was apparently an unauthorized procedure. The lady doctor, all sweat and perspiration, left the bata-traem (‘platter of food’) without eating a morsel.

As she left, I was reminded of another lady doctor at the private hospital the other day talking to me while my son was being operated upon by her colleague: “You know, our life style has changed. We have to make more money. We want to provide the best for our kids, their education. So, we must do this”.

Yes, indeed! We must do this! 

(Part 1 of 2 concluded)
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(This article was published in the daily Rising Kashmir in Feb., 2015: http://www.risingkashmir.com/murderers-of-kashmirs-healthcare-system-i/ )