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Thursday, Jul 30, 2020 13:00 [IST]

Last Update: Thursday, Jul 30, 2020 07:19 [IST]

TO WHOMSOEVER IT (or whoever) MAY (be) CONCERN(ed)

Dr. THEJASWI.S.G
It needed an optimist to think that humans can fly like a bird and he invented aeroplane. It needed a pessimist to think that humans can also fall while flying and he invented parachute. Both inventions are of utmost importance. The point being, yes be optimistic that everything will be fine. But at times of crisis management it is the pessimism that will prepare us for the worst.
In this scenario, did we remain too optimistic that the pandemic will not affect us and hence missed out the chance given by the so called “most stringent lockdown in the world” which was imposed in India between March to May 2020. The purpose of lockdown was, one, to contain transmission and second, to be prepared. It seems like we have failed partially if not completely in both aspects as exemplified by the raise in number of cases (which was bound to happen sometime anyway) and the lack of health action plan. By doing so, have we have lost the most important advantage point that was available to Sikkim i.e. to learn from other health models implemented across India as it took a while for corona virus to cross state border and reach us.  Do I sound pessimistic here? Yes, I do because remember parachute is important too.
By recent developments, as a medical officer was tested positive for COVID on 25th July 2020, the Emergency department at New STNM will be closed for a while. So hypothetically in a worst case scenario, my doubt is (although silly) if tomorrow, a medico turns out to be positive in flu clinic, will the flu clinic be closed for a week, and if an health worker is tested positive in COVID ward , then will the COVID ward will also be closed for a week? By applying the same to all the district hospitals and PHC, if some health staff gets infected (which is bound to happen at some point) will all those hospitals be closed? And finally left with CRH, and in case someone is tested positive in CRH, then that is also close? Finally making health system to come to a stand still and be a mute spectator of collapse of state of health? Was this not expected beforehand? If it was expected, then where is ‘Plan B’, ‘Plan C’ etc? Or was this itself ‘The Plan’: to deal with it on day to day basis?! Have we not learnt anything from other states or we waiting to learn from our own mistakes?!
 According to data of IMA National COVID registry data, of the total 1,302 doctors have been infected, 99 of them have lost their lives fighting against COVID ( as on 16th July 2020)1. So the risk of health workers to get infected and to progress to untoward outcome was expected. Hence, ICMR recommendations states that the dedicated COVID hospital has to be in an isolated building2. Having known this fact it appears that the primary fault was in combining the regular hospital and COVID hospital. Did the authorities have no other options available? I believe they had, such as any of the district hospital, Old STNM hospital, newly constructed oncology hospital, AYUSH hospital to name few. I am sure all those options would have been considered and weighed on pros and cons. The probable reason behind not opting for them could have been that they are ill equipped. Which raises the most important question which every citizen should be asking i.e why a Government District Hospital does not have enough infrastructure?
A District hospital, according to guidelines should be catering every possible high end service to a population of 1 lack in hilly areas. And there are 4 such district hospitals in Sikkim, which are basically serving as referral centres to hospitals in Gangtok. Which brings us to next question, why are these cases referred out of district hospitals, or for that matter even from PHC. The ideal referral system that exists elsewhere in India(which is considered as one of the most ill-equipped  health system) is that PHC will serve a population of 20,000(in hilly region), which refers cases to CHC (serving a population of 80000 in hilly region) and difficult cases are referred to district hospital3. Most of the cases will be dealt with in district hospitals and only those who need critical care or super speciality care would be referred to super speciality hospital in the region. Sadly, one of the best super speciality hospitals in the North East Indian region is burdened with treating simple cases such as normal delivery, acute gastroenteritis, gastritis, cut injuries, simple fractures, hernia, hydrocele to name a few. If the super specialty hospital was supposed to serve these cases then wouldn’t it be wise to close district hospitals and bring the medical staffs posted there to the one major hospital and have better work done here? Isn’t it a waste of resources? Buildings don’t treat patients, it’s the staff that run along these corridors like blood cells in an artery who treat patients. Which I am sure every health worker is practically doing right now at every centre. Often these staffs are the ones blamed for and victimised. We don’t blame a postman if he delivers a letter carrying sad news to us, do we?!  But is this the best that can be done? Is the health system comprising of one state referral super speciality hospital, 4 district hospitals, 2 CHCs, 24 PHCs, 147 PHSCs so poor that it fails to cater mere 7 lakh population?
The COVID 19 cases are going to explode and expand for sure but also will expose the lacunae in health systems across world. And it its nothing but a whistle blower of the apathy towards the collapsing health infrastructure across India and the world too.  But it is the timely intervention and preparedness that is going to help us treat it and manage the mortality by this as well other numerous health issues which are causing numerous deaths which is going unaccounted for. It is the mute citizens that is to be blamed for the present (poor) state of affairs. I say so because even in maternal care of new born it is advised as breast feeding on demand i.e feed the baby when it cries. So, if there is no cry heard from anywhere, whom to feed and what by whom!? Probably it is wise to think for ourselves that are we ourselves as a society are doing enough for the society and is it justified?!
(Disclaimer: Author is just a concerned citizen and not pointing out any mistakes as I believe I am not the wisest of all and I am sure these thoughts have already crossed many intellectual minds. It is just my personal opinion as a pessimist and thinking of the worst case scenario)
References:
1.https://health.economictimes.indiatimes.com
2. https://www.mohfw.gov.in/pdf/FinalGuidanceonMangaementofCovidcasesversion2.pdf
3. http://health.mp.gov.in/en/population-norms-for-establishment-of-health-institutions

Sikkim at a Glance

  • Area: 7096 Sq Kms
  • Capital: Gangtok
  • Altitude: 5,840 ft
  • Population: 6.10 Lakhs
  • Topography: Hilly terrain elevation from 600 to over 28,509 ft above sea level
  • Climate:
  • Summer: Min- 13°C - Max 21°C
  • Winter: Min- 0.48°C - Max 13°C
  • Rainfall: 325 cms per annum
  • Language Spoken: Nepali, Bhutia, Lepcha, Tibetan, English, Hindi