by Rashita Rather
Health is a fundamental human right and an essential pillar of socio-economic development. Public health and hospitals fall under the State List or UTs; therefore, have the primary responsibility for ensuring the health of their citizens. As far as healthcare in UT Jammu & Kashmir is concerned, it is nothing less than a nightmare for people living in remote and far-flung areas. People often travel long distances to access public health facilities in their respective districts. For minor health issues, they are not treated at Primary Health Centres (PHCs) because of a lack of facilities. Sometimes, PHCs have the infrastructure but lack essential facilities such as proper medicines, beds, doctors, etc. In many villages, even when doctors are available at PHCs, some of them are from the same village and hardly bother about punctuality or regular attendance at the Primary Health Centre. They come in the morning, mark their attendance, and go back home. They do their household chores and return later to mark their departure. This is how the system works.
There is a significant trust deficit in PHCs. People prefer to purchase medicines from nearby pharmacies rather than visit PHCs. There is also a racket involving pharmacies in villages that exploit people in the name of providing instant relief. They provide medicines without prescriptions, and the use of IV fluids is very common. For minor flu symptoms or minor injuries, patients are sometimes advised to take IV fluids with injections for so-called “jaldi aaram aa jayega” to extract money from poor and underprivileged villagers. Many people from remote and border areas belong to the labour class or work as daily wagers. For them, medicines without prescriptions are like instant noodles that provide instant gratification. As soon as they take them, they get relief and return to work. Nowadays, pharmacists have become the doctors of the poor labour-class section of our society. Our healthcare system at the grassroots level is deeply fractured and needs proper monitoring and appropriate medication at the earliest.
As far as major injuries and diseases are concerned, if someone from a village goes to the district hospital, the stark realities are revealed. If someone gets a check-up, they are likely to be deprived of one facility or another. Recently, one of my relatives fell from a height of 6–8 feet and sustained head injuries and other bodily injuries. The doctor prescribed a CT scan, which was duly conducted, but the story did not end there. She was told to wait 10–15 days for the CT report. Can we believe that this is the condition of a so-called medical college in District Rajouri? We often hear, “Doctor chutti par hai.” Is it possible that in a medical college there is only one doctor responsible for preparing reports? There appears to be little accountability when it comes to the precious lives of people in our society.
Recently, a woman died during a C-section, and her family raised serious allegations against the administration of the district hospital in Rajouri, but there has been no accountability so far. The rising number of C-section deliveries at the medical college in District Rajouri also raises concerns for an educated and rational society. Institutional deliveries are, in themselves, a positive step, but that does not mean that every delivery should be conducted through a C-section. Our healthcare system is sicker than the people it is meant to serve. People are assets of a state; if an asset is not taken care of, it will ultimately become a liability.
One of the most striking issues in District Rajouri is the privatisation of the healthcare system. Many doctors at the medical college are running private clinics. Some doctors appear to be more inclined towards their private practices than their government duties, for which they are paid handsome salaries. There is a strong nexus between hospital administration and private clinics, which is eroding the values of one of the most important public infrastructures: healthcare. Privatisation is not inherently bad, but excessive privatisation is like a cancerous cell that multiplies day by day and, in turn, increases out-of-pocket expenditure for citizens, especially poor and vulnerable sections of society.
Rajouri is a border district, and its proximity to the Line of Control (LoC) exposes it to periodic disruptions. Tribal and marginalised communities face difficulties in accessing regular healthcare facilities. Shortages of diagnostic equipment, ICU beds, medicines, and emergency services act as push factors for people to travel to Jammu and Srinagar to access healthcare facilities. Many precious lives have been lost during medical emergencies while travelling 4–5 hours from Rajouri to Jammu for treatment. If the healthcare system of our district hospital were better, people would not have to cover such long distances even for minor health issues.
There is an urgent need for certain measures to be taken by our elected representatives to ensure better delivery of healthcare facilities, which are a fundamental right of every individual. These measures include filling vacant posts of doctors and specialists through targeted recruitment; upgrading PHCs with modern diagnostic and emergency facilities; strengthening telemedicine and digital health services; deploying mobile medical units for tribal and remote populations; improving road and ambulance connectivity; increasing health expenditure for border and aspirational districts; and promoting community participation and preventive healthcare. “A health system is only as strong as its ability to reach the last person in the queue.” This principle is particularly relevant for Rajouri’s remote and vulnerable populations.
The author can be mailed at ratherrashita86@gmail.com
