Kashmir Needs More Healthcare Now but, Without the Internet, It's Getting Less

Over 3,000 applications for assistance under the Centre's Ayushman Bharat scheme have been languishing at the 'pending' stage since August 5.

Srinagar: On August 26, a young patient running a high fever was rushed to the out-patient department of S.M.H.S. Hospital in Srinagar. The junior doctor on duty was caught in a predicament when he found the patient’s symptoms didn’t fit any particular diagnosis.

In other circumstances, he would have logged onto his go-to health website and looked for the symptoms there. But with no internet connection and all telephone lines down, he could neither understand the ailment properly nor call a senior doctor to discuss the problem. So he halfheartedly went ahead with his clinical judgement and administered treatment.

Another doctor in the hospital’s casualty department had a similar experience in September.

“Internet access comes handy in such situations,” the second doctor said on condition of anonymity. “I would have researched the problem, … making the diagnosis more accurate.”

“As a doctor, I couldn’t have risked giving [the patient] the wrong drugs. I delayed the treatment and asked him to return the next day. Meanwhile, I took my seniors on board to develop a proper diagnosis.”

The situation was much worse when it involved a surgery.

“There were many patients who went through a preanesthesia checkup before the surgery and required another review from a senior physician,” the second doctor said. “Due to the lack of communication, we couldn’t track down the senior doctors on time. So a staffer would be sent from one department in search of the seniors, who would be in another department at the time. This created a lot of confusion and delayed the surgeries.”

To make matters worse, some of the hospitals ran out of medicines and some equipment during the communications blockade, and couldn’t place new orders.

“Essential kits like Trop T and Venus blood gas kits, which give insights about various diseases, are scarce.”

Postgraduate students were hobbled as well. They said none of them had been able to make any progress on their work since August 5, when the blackout began.

“We need references to write the synopsis. How can we progress when there is no internet?” one scholar at the Government Medical College in Srinagar asked.

The Centre restored internet services in 80 hospitals from the evening of January 1. “The government has also directed restoration of internet broadband services in respect of all other government hospitals as well, where local bottlenecks like connectivity status, billing problems, etc are being worked out and fixed on priority,” a spokesperson’s statement added.

However, hospital staff have found that only the heads of hospitals and selected senior officials have been able to get online. One official at GMC Srinagar said, “There is no access in any ward nor in the libraries of hospitals.”

They share their plight with other hospitals in the valley, as well as non-government initiatives trying to improve access to good and affordable healthcare.

For example, the blockade has set back ‘Save Heart Kashmir’, a programme that three doctors initiated in 2017 to provide cardiac healthcare assistance during emergencies based on WhatsApp messages.

Dr Afaaq Jalali, a senior physician associated with the programme, said that its members had to find other ways to work around the internet barrier.

“When phone connections were restored in Kashmir, our numbers were listed on charts that are pasted at all district, sub-district, primary health centres and other peripheral hospitals. We are available 24*7 to attend to their calls and offer expert advice on how to tackle the emergency,” he said.

Dr Nasir Shamas, also a member of ‘Save Heart Kashmir’, said the blockade forced them to invent and prepare better for such emergencies.

“After August 5, doctors have been trained on all medical emergencies, unlike before, when they were only trained in cardiology. This is done so that if such a scenario arises in the future, we will tackle them efficiently.”

The group currently has around 1,200 members and has catered to over 38,000 patients thus far.

In an ironic but unsurprising example of anti-exceptionalism, government health  health schemes like Ayushman Bharat have also been affected. Many patients avail of benefits from this scheme for dialysis, gall-bladder removal, breathing disorders, cancer care, cardiac stenting and total hip replacement.

The Centre launched the scheme in Jammu and Kashmir in December 2018, since when more than 30,439 patients have registered for an estimated treatment amount of Rs 20.2.

But since August 5, over 3,000 applications for assistance have been languishing at the ‘pending’ stage.

Similar, the state government had conceived of the ‘102’ and ‘108’ toll-free ambulance services to deal with emergencies and to transport referral patients in 2011. By a November 2019 deadline, the government was expected to roll out 416 ambulances.

But according to an official of the National Health Mission, the Jammu and Kashmir government has only procured around 120 critical care ambulances thus far.

“We can’t make them operational without the internet. We need an internet connection to monitor them because they are GPS-fitted ambulances,” the official said.

Rashid Para, the state’s programme manager for emergency care, only said that the vehicles will be made available soon in the new union territory.