Kashmir’s ill-equipped health system and India’s push for tourism led to a Covid crisis

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Adil Rashid

In the first week of May, Qazi Idrees, a 29-year-old government employee, was making desperate calls to get a ventilator supported ICU bed for his father, Qazi Aftaab.

Aftaab was admitted at JVC Medical College and Hospital in Srinagar, which was severely understaffed and under-resourced.

“When my father required high-flow oxygen, they kept him on low-flow,” Idrees told me. “They asked us, as our father’s attendants, to give him injections,” Idrees said.

How could we? It’s a sophisticated set-up and what if we did anything wrong, who would be responsible? They even asked us to do suction by ourselves, how could we do it, what are the doctors there for?” Qazi Aftaab died of COVID-19 on 17 May, along with 73 others in Jammu and Kashmir.

His case is emblematic of the critical shortage of oxygen, drugs, healthcare staff and hospital beds of Jammu and Kashmir’s health systems.

Amid this public health crisis, as COVID-19 cases and deaths have been rising dramatically in the region, the territory’s administration has been creating hurdles for local NGOs and civil-society organisations that have been filling in the gap, providing essential oxygen and drugs.

Several doctors and local leaders told me that the current spike in cases in Kashmir was, at least in part, because the administration encouraged an influx of tourists in an attempt to portray Kashmir as having returned to normalcy.

On 4 May, when Aftaab was admitted at JVC medical college, 4,650 people tested positive for COVID-19 in Jammu and Kashmir.

Idrees told the scribe he had initially been glad when they had been able to find a hospital bed for his father, something that became increasingly hard as cases in Kashmir surged up.

But as he discovered, the hospital was struggling with its limited resources, and said that the doctors were using the same amount of oxygen in regular oxygen beds and in intensive-care unit beds.

“Initially they moved us to a bed, which they said was an ICU bed, but they used the same 60-litre oxygen machine.

They even told the district commissioner, who had called them on our behalf, that we were provided an ICU and the patient is stable. It was a lie. No care is being given to patients.”

Idrees also learnt that families were expected to procure the drugs and manage the patients themselves.

He said that when his father was finally admitted to an actual ICU, it had only two nurses, who did short shifts, and had no doctor after 9 pm. “They provide no care as they are supposed to,” he told me. “This is a wretched disease. It affects you mentally even if it is your kin who has it.

If somebody were sick normally, your relatives and others would come to the hospital, we’d get some moral support.

That’s not the case with COVID; you worry about your father, then about yourself, about catching the infection, and then you realise that you are on your own, nobody is coming to help.” Shafa Deva, the medical superintendent of JVC medical college did not respond queries.

There has been a historic lack of medical infrastructure in the region, where the Indian government’s concerns over security have often outweighed its concerns over public welfare.

In April 2020, medical professionals voiced concerns about the capacity of the region’s medical infrastructure to manage a crisis such as COVID-19.

The same month, the Jammu and Kashmir directorate of health services published a circular threatening prosecution against outspoken doctors.

Over the past year, the Kashmir health directorate has been increasing the number of beds, oxygen and equipment necessary to handle rising COVID-19 cases, but several doctors told me that the current spike in cases dwarfed what they had prepared for.

“The Kashmir valley has 2,459 oxygen-supported beds, only 752 of which could handle high-risk patients,” Mir Mushtaq, the spokesperson of the directorate of health, told me in the last week of April.

However, the administration has lost crucial time is equipping hospitals with ICU care facilities.

According to the government’s daily bulletin on COVID-19, on 16 May there are only 133 ICU beds available in Kashmir.

On 31 May, Mushtaq told me, Kashmir had 2,035 oxygen-supported beds, 67 ICU beds and 112 ventilators.

However, there seems to be a discrepancy in the government’s data, because just a day earlier the government bulletin noted that Kashmir had 154 ICU beds, 83 of which were vacant.

The state has also been unable to utilise ventilators well. A report from April 2020 showed that Kashmir had only 93 ventilators for a population of around eight million.

On 21 February 2021, the local newspaper Greater Kashmir reported that the union government had allocated 908 ventilators to Jammu and Kashmir of which 892 were installed.

However, a senior official with the health department told me that many ventilators were lying unused. “These are sophisticated machines,” he told me, requesting to remain anonymous.

“To properly function each ICU requires at least a specialist doctor, that is an anesthetist, a trained technician for ventilator maintenance, a nursing orderly to cater to the patient’s non-medical needs, and a nurse, who all are to be supervised under a registrar who will in turn report to a consultant.

The government had not used the time between the last wave and now to recruit the necessary manpower. As a result, at several places, ventilator facilities lie unused.

Belatedly, the government has resorted to contractual recruitment through the National Health Mission.”

On 24 April, Mohammad Yasin, the mission director of the Jammu and Kashmir wing of the NHM, issued a notification inviting applicants for 30 posts for anaesthesia consultants through walk-in interviews on 28 and 29 April. “But even that is woefully inadequate,” the health-department official told me.

Alongside ventilators, there has also been a lack of drugs commonly prescribed for COVID-19. On 20 April, AG Ahangar, the director of Sher-I-Kashmir Institute of Medical Sciences, Srinagar’s biggest hospital, said that Jammu and Kashmir was suffering shortage of remdesivir.

The same day, Atal Dulloo, the financial commissioner of the territory’s health department said that there was no shortage in the state. However, both doctors and relatives of patients told me that this was an absurd claim.

Two doctors I spoke to, one from SKIMS and another from Shri Maharaja Hari Singh Hospital in Srinagar, both of whom wished to remain anonymous, confirmed to me that since mid April, the hospital had lacked sufficient stocks of remdesivir. Idrees, too, told me that he struggled to get the drug.

“The consultant had recommended remdesivir injection, but my father wasn’t given the medicine for his first two days in the hospital,” Idrees said. “The doctors ticked that column recording that they did provide it. I figured they didn’t have it in the stock.

The consultant told me the administration wouldn’t say so, even if it was true. Finally, I got them from the market. They cheated the treatment sheet for a steroid medicine in the same way as well.

On one night they didn’t even have paracetamol.” Dulloo did not respond to questions emailed to him.

On 17 May, the Hindustan Times reported that, despite a lack of oxygen for hospitals and homecare in Kashmir, five oxygen-generation units meant to be deployed in hospitals in Kashmir were diverted to Hindu-majority Jammu.

Two days later, The Wire, reported that it was three oxygen-generation units that had been diverted.
— Courtesy The Caravan