Garam Chashma Diary
Significant improvements have taken place in the health sector during the past 5 years but the problem of coverage to include vital sectors relevant to the context of Chitral still persist. Hopefully this will be addressed during the next 5 years. Critical patients still continue to be referred to Peshawar and quite a few cannot make it owing to long distance and high cost. Though few more specialties have been added during the last 5 years in the DHQ Hospital but the problem of retaining specialists, provision and maintenance of equipment, cleanliness and work ethics have yet to be addressed. Here it must be admitted that DHQ Hospital Chitral has seen fair amount of improvement during the past 5 years, which include availability of medicines, better hygiene and related services but given the rush of patients it is awfully insufficient and not fully adequate even in the areas of specialties that it offers. Health care in THQs and BHUs still presents quite a challenge. Deficiencies in these layers compel patients to flood the DHQ Hospital thus reducing its effectiveness as a secondary facility. THQs and BHUs just cannot operate as filter clinics due to lack of staff, shortage of medicines and diagnostic facilities. Partnership hospitals offer a new set of challenges as these have yet to reconcile their commercial considerations with the citizen’s right to free health care guaranteed by the constitution and being implemented by PTI government.
THQ Hospital Garam Chashma, built decades ago, was never fully functional till recently. Most of its sanctioned posts remained vacant and there were no diagnostic facilities. After having failed to move successive governments to improve the situation, the people requested AKHSP to take over the facility by invoking the government’s partnership policy. Since then during the past 3 years the hospital infrastructure has been improved with donor support. State of the art equipment have been installed including diagnostic facilities and opportunities for E medicine.
The flop side, however, became apparent when the government introduced free health care in hospitals. The catchment area is very poor and unable to pay the cost of treatment. Although there is the facility of insurance it covers only the indoor patients who are less than 1% of the patient intake.
As a result, not only patient intake has decreased but also cases of self-medication and quackery are on the rise much to the detriment of public health and there is no monitoring system in place to check this tendency. The situation is no different in areas where government facilities are underserved and have no proper skilled manpower available around the clock.
The prevalence of quackery on the one hand and lack of hygiene consciousness on the other are posing serious threats to the entire government health care system. Patients come to referral hospitals with acute complications after having availed faulty services and few after having contracted dangerous infections due to re-use of used syringes, non-sterilization of tools and wrong medication. There are paramedics and technicians who are playing useful role in areas having no access to quality health care or its prohibitive cost but the question as to what a technician’s clinic can or cannot do has yet to be defined and enforced through effective monitoring by an independent regulatory authority. We cannot take chances in view of the emerging bacteria resistant disease patterns and high cost of treatment.
The only way out of this predicament is government intervention to provide free of cost basic health care to its citizens as a basic right. In areas where private or NGO sectors are to be co-opted, the MOUs must ensure protection of this right, failing which writ jurisdiction may be invoked by any concerned citizen. In case the government is not willing to retake and run the partnership hospitals without compromising on quality, then these should remain in private hands for the purpose of management only while enjoying full budgetary support of the government so that citizen’s right to free health care is ensured and violation of the right is not attracted. Without making the services of partnership hospitals free or affordable through subsidy, we may even lose the investment that we have made on the infrastructure and other state of the art facilities. Poor access would mean that the state of the art machines would depreciate with manpower remaining idle and losing professional growth without much to offer to the people. It is a lose-lose situation.
Another issue agitating public minds with regard to partnership hospitals like the THQ hospital Garam Chashma, originates from the unrealistic expectations given to the people to attract voluntary service. Much of these promises remain unfulfilled. Except for a gynecologist, there are no specialties. Dental surgeons cannot be retained and this critical emerging sector is mostly handled by a technician. Being local he is looked upon as the only saving grace providing dental care which is not always foolproof given the level of sophistication that dental care involves and incidences of infections caused by poorly served dental facilities and saloons. The risk is simply prohibitive and so is the cost of dental care. It is ironic that more expensive state of the art dental machines are available in THQ but not the facility of RC which has the potential to provide significant income to the hospital to offset cost of free service in the remaining areas of dental care, should the hospital go for it. Similarly there is no general surgeon to carry out minor or medium sized surgeries despite there being state of the art donor funded OT. Injury patients or those with acute pain like appendicitis etc are referred to DHQ 45 kilometers away. It is only a miracle that many survive the treacherous journey, at times carried on foot during road blockade due to snow and flooding and these are quite frequent.
Ideally speaking and in keeping with their promise, the sponsors of the hospital should, apart from dental surgeon and at least three MOs (one as medico-legal officer to help people with police cases) including one LMO, provide specialists including a surgeon, physician and a psychiatrist to be expanded to cardiac care etc as warranted by patient inflow. Patient flow in turn would depend on cost. If subsidized or written off through grants and budget support the patient flow is bound to increase manifold given the 75000 strong population base available locally with possibility of Afghans accessing it from across the border. This will also solve the problem of self-medication, quackery and other local therapies which are part of the problem than solution. Ability to retain professionals may be improved through better incentives like housing, training and motivation. Last but not the least responsive management is the key to solve many problems, which is sadly lacking.