A dream for 11 solid district hospitals in Nagaland

It is a wishful dream. Maybe someone else has it too. And I hope I don’t spoil it by sharing it now, because I feel more time should be spent on research before putting it out in public. It is a work in progress.

A patient from Pungro in Kiphire district has to travel about 290 kms to the State Capital for an Ultrasound and most of the other routine diagnostic tests. Also, apart from the doctor’s prescription pen, treatment facilities are very limited. Patients from Mimi or Thanamir villages have to walk for half a day or hire a vehicle to reach Pungro. For people in this area, the time wasted, the labor days lost, the worry, the difficulties in finding a place to stay in the Capital, etc add up to the travel and stay expenses, and medical bills. So, it is a hard decision to embark on such journey to seek for medical care. Such patients tend to reach Kohima in critical condition after complications have set in. We blame such village folks for their ignorance and scold them for coming late. But we know that we recover from certain illnesses without medicines, and the difficult conditions of such people force them to bargain and risk too much. For it is not rocket science to know that if one gets sick, one has to visit the doctor.

This dream that I have is that one day (hopefully sooner than later), patients from such far flung villages have to travel, at the most, to their respective district headquarters. In their district hospitals, comprehensive medical care is made available - routine diagnostic, medical and surgical packages – so that only in extraordinary circumstances, cases have to be sent out for referral. So, a patient from Pungro has to travel only about 40 kms and save 250 kms. She would not only receive early medical care and save the additional journey expenses but would also be cared for in familiar surroundings of her own district. She would feel more secure as it is nearer home and the relatives would also get more flexibility and more helping hands in caring for her.

This isn’t asking for too much as it is simply asking to put in place what a district hospital should be like. Some district hospitals are doing better than others, but in majority of them there is a need for major fixing. The blame game is a vicious circle where there is no end. You trace the reasons for the sorry state of our hospitals and you end up having your ears full but no clear vision for a way ahead. I in no way would like to project my own department in a bad light and you’ll see that this article is far from picking at its faults. The factors responsible for the present state of our district hospitals are multi-factorial anyway. No single entity can be solely blamed.

The health service delivery system in India is like a pot of ‘galho’. The ingredients are so mixed up so that it is very difficult to make out what went in the pot. Each government would add some new ingredients during their tenure, stir the pot a bit, and go away. The next would come and do the same. There are over a dozen vertical national health programs which are more or less, independent of each other. The programs have their own elaborate systems of functioning with separate employees, reporting through separate formats, aiming to achieve specific targets, and funded by different agencies. But the sum of these vertical programs and the general health services form a very confused health care delivery system. The programs are all so messed up that one doesn’t know what the other is doing. We, who are involved in a specific program, are so busy in our own worlds that if we are in-charge of the liver, we don’t know if the kidneys are suffering, much less that we are all body parts of a whole person. No matter how useful the specific disease programs are, the general health services is the most important and the most neglected in our health care system. The national programs were meant to support and improve the general health services, but I think they have taken us away from it. That I think is an important cause for the state of our district hospitals. The NRHM has been trying to integrate these different health programs to form a coherent health care delivery system, but that too is still a work in progress. So, we are caught in this juncture which is not of our making but is a confusion that is felt in the whole country.

Some States which have sufficient local resources and clear vision are able to stir through this state of affairs well. As health is a State subject, we also need to carefully plan for the health care delivery of our State, over and above what Delhi tells us to do. What needs to be clearly understood is that the various national health programs are not the health care delivery system per se, but only supporting wings. They all require a well functioning general health services, consisting of the subcentres, primary health centres, community health centres, and the district hospitals. And above all, we need well functioning district hospitals. And the day-to-day functioning of the district hospitals is beyond the purview of the national health programs; it is in the hands of the State government. The State, with its limited resources has constraints in keeping our hospitals in healthy shape. And as stated earlier, the national programs have diverted our attentions away from this primary task.

The first and the most important thing to do, is for the State to allocate its budget more in health sector. There is no getting around this if we want to see improvement in the health services of our State. Next, with proper planning and strong policy decisions, arrangements can be made where the limited resources, like technical manpower (e.g. doctors) can be relocated from the lower levels to the respective district hospitals. With the hospitals functioning with multiple specialties, they can become learning grounds for medical officers, and patients receive comprehensive quality medical care under one roof. The doctors can visit the primary health centres on specific days of the week and perform their duties in rosters and no one is overburdened. A medical officer may be assigned to fill the multiple reporting formats and other paper works, and in turn, he may be relieved of emergency duties. Some may not agree to this arrangement but the idea is that whatever the arrangement may be; overall, there is a healthy combination of work, leisure, study, and family life for the employees. Such arrangements are of little relevance for a newspaper article as this, but it is simply to show how we can plan to work more effectively with the resources we have. With clear vision and elaborate planning, we can do a good job with what we have. Lastly, and the thrust of the write-up is this: The other departments, civil society groups, faith based organizations, and individuals need to play a much more supportive and pro-active role in building up our district hospitals. Criticisms and voicing of grievances can be constructive. But there is a need to go beyond that to actively contribute towards our hospitals. The respective District Planning and Development Board need to have the district hospital in their agenda for development activities. The Power Department can help by supplying special lines to the hospitals because almost all of the modern medical equipments run on electricity. The PHE department can ensure that there is sufficient water supply, because it is useless to talk of sanitation without sufficient water supply. The local MLAs can donate an Ultra Sound machine this year, a generator next year, and so on. The tribal hohos of the respective districts can mobilize local support to construct certain rooms with locally available materials. The church youth can offer to clean up the hospital surroundings every month or quarterly. Individuals can contribute decorative items to make the hospital wards more homely. Some families, whose love ones recovered from the hospital, can donate a television set or a table tennis table for the recreation of doctors. There are umpteen things that groups or individuals can do for the hospitals. Ask the Medical Superintendent, ‘what can we do for the hospital? What is the pressing need now?’ Irrespective of who is to blame for the lack of this equipment or that medicine, something can always be done if we are concerned. It is a commendable job that The Naga Blog, an online group, volunteered to renovate a part of the Dimapur district hospital. The local MLAs, tribal hohos, students’ bodies, church councils, and individuals can take cues from that.