Dr Satya Dev Gupta The medical fraternity including Jammu Doctors Forum is annoyed, frustrated, and discontented when unhealthy remarks “Senior doctors don’t attend the Covid patients” by some persons at the helm, against the high ranked faculty members for controlling the pandemics of Covid19, when all the situation has slipped out of control. The Central Government had sent a team of experts to analyze the reasons for the higher mortality rate in the Jammu division in comparison to Kashmir valley. The Corona meter of the last 24 hours records less infected cases in Jammu with tremendous higher mortality. As It is easier to shift the blame to others, in that context some persons appeared cleverer in making the scapegoat the persons who are innocent, harmless, employees, and non-aggressive in a very effective way. So, these people from the Government managed to make a game plan in declaring and propagating the responsibility of guilt to the senior members of the medical fraternity. The present scenario of mismanagement is the reflection of the past 70 years of ill-treatment towards Jammu by Kashmir-centric governments, whether it might be of state or central. Leaving a few examples, the developmental projects whose foundation stones were laid down years together have not been completed so far. About 20 years ago then Central Minister Lt. Sushma Swraj assured to build AIIMS like an institution in Jammu, reduced to an ill-equipped and staff deficient health care center. After that, no further concrete advancement was ever made. While Valley of Kashmir is loaded with good hospitals even at the district level, whose infrastructure and working model are better than even prestigious GMC Jammu. Srinagar city itself has 2 Sher-e- Seoura Kashmir hospitals (one at and the other at Bemina) 10 other high-graded hospitals including various associated with GMC Srinagar. It is a tale of travesty when the Indian Parliament passes a resolution to establish one AIIMS in Jammu, then Chief Minister Late Mufti Mohammad Sayeed planned for “AIIMS in Kashmir “. Furthermore, although appreciable move, when Sher-e-Kashmir Institution was to start in the early 80s, a lot of medical and paramedics were sent for better education and special training in PGI Chandigarh on deputation for graduation and post-graduation. This high profile and good quality knowledge were later on transferred to coming generations for better standards of treatment. The forefront warriors in fighting this disease, are the health workers from the discipline of Medicine, Anaesthesiology, and Pulmonary Medicine in hospitals. Medicine people receive the patients and plan for drug therapy, Anaesthesiologists executive to tackle most of the oxygen-related enigmas in oxygen therapy like low flow, high flow CPAP BIPAP, and Ventilators, while Pulmonologists analyze overall respiratory problems. The doctors from other specialities are called as and when required. Having all these let us dissect out where the fault lies and what are the recommended measures to solve the problems: Towards Solution In the first wave of Covid-19, the pandemics care bed strength was 190, but now the Corona care beds have gone up to 875 in GMC only. The government is further planning to expand high-level care to surgical wards 4 and 5 in near future. The service staff strength has not been expanded in proportion to the requirements. In the Medicine Department, the requisite strength of consultants is about 33, while 11 are posted, 2 are suffering from Covid-19 and the remaining 9 are working. Most of them are either professor’s associates (senior category) and some are assistant professors and lecturers. Similarly, other departments have more than 40 percent shortage. For a long time, the vacancies haven’t been fulfilled. It is learned that all the senior consultants often take rounds and called as and when required and spend more than 15 hours in patient’s care in the hospital or on teletherapy. Planning of critical care and ICU in India. In news channels, social, public or print media whenever talk is about the ventilators, it is always impressed upon that there is deficiency of Ventilator technicians. Previously, it was propagated about the dearth in the number of ventilators and ICU beds for fighting against the Covid. The norms of ICU beds in the initial period, with the commencement of ICU, it was documented to have one to two per 100 beds in a health institution. Indian Society of Critical Care Medicine (ISCCM) guidelines on planning and designing ICU were first developed in 2001 and later updated in 2007. These guidelines were adopted in India and other developing nations. The academic programs were planned for NABH (National Accredited Board for Hospitals and Healthcare), Critical Care Medicine, Supper-specialty (DM) Doctor of Medicine, (DNB) Diplomate National Board, and other related courses. IDCCM, IFCCM, CTCCM, and IDCCN (Indian Diploma in Critical Care Medicine, Fellowship, Certificate and Nursing respectively) of Indian Society of Critical Care Medicine (ISCCM). Indian Diploma in Critical Care Medicine (IDCCM) at present has more than 12,000 members, 2000 quality ICUs, 65 (IFCCM), CTCCM and IDCCN courses but pandemic of Corona has shattered all the norms to such an extent that the enormous ventilators ICU beds are falling short. World Health Organization (WHO) had declared Covid19 as a global pandemic on 11 March 2020 while all the countries have been working hard to cope with this challenge, even the most developed countries fell short of their resources in containing this dreadful disease. India, having limited resources, capabilities, fragmented and fractured health care system both public and private sectors unexpectedly fought with COVID-19 pandemic successfully. The Center for Disease Dynamics, Economics, & Policy (CDDEP) of India has estimated ICU beds and Ventilators in 37 states of the country. The data was obtained from National Health Profile (NHF) for the public sector indicating about 7 lac hospital beds. No such data could be found for the private sector. However, the percentage break-up of public and private sector hospitals was obtained from the National Statistical Office (NSO). Since a large number of patients are being attended by the private hospitals, the public-private partnership may become a boon to face Covid-19 challenges in an effective way that too at district level to surge the bed capacity. As elderly and co- morbidly affected patients may need ICU and Ventilator, there should be plenty of logistical support for health-care. Pondering over the data by NSO and other agencies, at present it is estimated that the critical care beds constitute 5-8 percent of the total hospital beds at large medical facilities in India. It is also assumed that the number of beds in hospitals is about 19 lacs, out of which ICU beds would be around 95000 with 50 percent having equipped with ventilators. Seeing the unexpected effects of Covid-19 India needs extra more than 500,000 ICU beds and 350000 medical staff nurses along with the ICU experts to meet the challenge of Covid-19 in the next few weeks says, Devi Prasad Shetty, a renowned surgeon. Health Care in Jammu and Kashmir Since last year after the first wave of Covid-19, there is a tremendous improvement in health care. Oxygen plants were installed, bed strength with oxygen and without oxygen, ICU beds, with and without the ventilators increased. Surgical wards 4, 5 were converted into the Covid wards to cope with the heavy influx of Covid patients. DRDO 500 bedded hospital in Jammu has started to work since 26th May 2021. The authorities have ultimately acknowledged the importance of Anesthesiologist as an asset and posted a sizable number of anesthesia doctors in DRDO hospital. The Ventilators in the peripheral area now are being shifted to central hospitals where their utility could be made optimally. The authorities must also rectify their long-pending mistake for not setting up “Cadre Based Specialist Seats” lists pending since 2007-08. Lieutenant Governor is humbly requested to take personal interest as author has already highlighted this problem in previous articles and further appeals to the Government officials to take up their requisite initiative towards the health care improvement. The anesthesia doctors’ posts should be increased in many folds from community hospital level to AIIMS levels (including sub-district, district, Medical College, and other higher institutions). Training of trainer’s courses should be started to impart the knowledge to handle the Ventilators and other equipment so that many lives could be saved. The author, who has retired from the active services in 2007 as Head of the Department of ICU and Anesthesia can still contribute to this campaign if ever need arises or called (The author is President – Jammu Doctors Forum) feedbackexcelsior@gmail.com
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