Thursday, June 24, 2021

Mismanaged healthcare

There is no second opinion that the state of healthcare in Nagaland is suffering from acute mismanagement and neglect. What is lacking in all healthcare institutions is the absence of a hospital administrator. Hospital administration is a specialized subject and every consultant, howsoever excellent he may be in his specialized line, cannot administer a specialized institution. And an instance of mal-administration is running a healthcare institute like an office. Casualty is the face of a hospital. It looks like a fish market being attended by junior doctors. It needs to have senior doctors from each specialty. On infrastructure, we can safely say that we are not lacking as compared to other states. However, the main problem is mismanagement of the infrastructure and the personnel involved in healthcare. Firstly, the district hospitals (apart from the private ones) in Kohima and Dimapur are forced to handle the entire load of the State. This is because of lack of good primary health care throughout the State. If the primary health care in rural areas and districts is up to the mark, there will be very much less load on hospitals in Kohima or Dimapur. Incidentally, Government has made it mandatory for freshers to serve in rural areas. In fact, it seems like a punishment! The need is for fresher’s to work with senior doctors for at least 3 to 5 years to gain experience. In stead senior doctors with experience should give some time in district hospitals and rural areas. They can filter many cases leaving lesser load on major hospitals. An endocrinologist and a neurologist in peripheral hospitals would be a great help. Only specialized cases need to be referred to Kohima or Dimapur. At present every one even with minor problems lands in these two districts. The specialty institutes have virtually turned into a general hospital. There are district and sub-district hospitals in all parts of the State. Some of these may be quite well equipped but these are supposed to suffer because of the absence of specialists and consultants. Similarly, some of the primary health centres have always the problem of doctors not staying there due to the problem of accommodation and other facilities. While talking of so called malpractices which now include the banned so called private practice by Government doctors is only a tip of the iceberg. Firstly, there need not be a ban on the private practice by Government employed doctors if this is done in their own private time. They need not be given any non-practicing allowance but can practice before or after their duty hours. However, on rotation some doctors could remain available even after working hours which should be from 8 am to 6 pm. One cannot go by labour laws as regards healthcare. This is essential to cater for patients all of whom cannot be attended during duty hours. Everybody knows there is a great dearth of doctors especially the specialists. Apart from private practice, there are many other malpractices. There is supposed to be a nexus between the pharmaceutical companies and doctors on one hand and between diagnostic centres and the doctors on the other. Pharmaceutical companies give many perks to doctors for prescribing particular brands. Apart from household items, they are even offered foreign trips! Most of the diagnostic centres have a liaison with some doctors who ask patients to get their investigations done at some particular centres who reimburse them part of the charges levied on patients for various tests. Sometimes poor patients are asked to go for a number of tests which may not be essential for establishing a diagnosis! Incidentally, Nagaland is probably the largest consumer of drugs in the whole country. The number of pharmacies is countless. One finds a pharmacy at every nook and corner. Strangely, pharmacists can dispense any drug even without a prescription. Antibiotics and many other scheduled drugs are sold over the counter like sweets from a grocery! Apart from selling all types of drugs just over the counter some of the pharmacists especially in remote areas have been observed writing even prescriptions! If one goes on enlisting the ills of the healthcare, it will not end. The point is if the Government is sincerely and honestly interested in improving the healthcare both at the basic as well as at the specialist level, an overhaul of the entire system is required. The sooner it is done, better it would be for the good health of all!