Saturday, November 28, 2020

Better healthcare

In the past, infant and maternal mortality rates were high in our state. Though expected to decrease by the latest technology and research in favour of early diagnosis and prompt treatment, nothing much has changed even today. The vulnerable age groups like kids and elderly patients reach the so-called tertiary care hospitals in Dimapur or Kohima very late from their primary source of referral because of so many factors including transport, late decisions by referring doctors as well as attendants, etc. They are being referred because of unmanageability at their primary source, and during the process they already develop complications. On reaching the two districts hospitals they are not treated as expected due to lack of facilities and resources. The fault lies at various levels, for example, at administrative level, technical level and community level. In our state the decision makers are mostly non-professionals and their followers are blue eyed in-experienced directors, heads of institutions and other high officers who simply are not able to implement things properly. They are either pure doctors or pure yes-men who neither remain good doctors nor good administrators. By forcing them into chair doesn’t mean that they can deliver things. By doing so we have not only wasted so many good scientists and academicians but also made systems defunct. We lack management skills. Outside the state successful private hospitals have executive officers who are doctors with training in management skills as well. In the past we had many good doctors. They were dedicated and sincere because their mind was not occupied with private practice mania. They used to spend maximum time within hospitals with the result junior doctors would also attend to their duties regularly and remain dedicated to their job. As long as a doctor tries to step on two boats at a time he or she cannot be sincere to patient-care. There will be fraud and corruption. Central government has many good schemes and programmes for health care like NRHM, RNTCP etc., but many doctors and para-medical staff try to sabotage it for their own vested interests. Let us develop better private health sector but not at the cost of government resources. Let us hire better specialists and super-specialists for private nursing homes and clinics but spare those who are meant for the poor patients who can afford treatment costs only in government hospitals and health centers. There are so many doctors without jobs and so many struggling for post-graduation. They can prove better for private sector, of course with the initial help of government institutions. Here simply reading books does not make one a good doctor. One need exposure to an environment of experienced seniors especially in a well equipped hospital at district and sub-district level. And we are wrong when we post fresh doctors to work in remote areas during initial years of their service. Rather, a fresh MBBS doctor should perform some mandatory years at district or sub division hospital under the guidance of seniors in addition to mandatory internship before qualifying for peripheries or remote villages where they have to work independently in all fields of medicine and surgery. In this way they will develop confidence and rate of referrals to tertiary care hospital and district hospitals will fall automatically. There should also be accountability at each and every level and in-service training should include periodic quality assurance training for both trainees as well as trainers. On the same line, Drug Act is just on papers but it needs to be implemented in letter and spirit. The profession is to be respected but unfortunately everyone is allowed to play with human life by issuing licenses and registration certificates through corrupt means. Hypocrisy is the rule in our state which is to be discouraged. At the same time private sector has to be enhanced and encouraged as an entirely separate entity. For all doctors, junior or senior, clinical or non-clinical, general or in administration there should be choice for only one – either government service or private sector. By doing so we can produce dedicated professionals. Thus, curative and preventive health care shall come to perfection and overall mortality and morbidity rates will decrease. Besides there should be medical insurance mandatory for all and against all diseases so that all socio-economic classes in our society have equal opportunity for better health care.