SRINAGAR: Doctors say that about 70 per cent of rural patients referred to city hospitals for treatment can be spared the hassle of travel if health institutions in the districts are strengthened.
At the same time, they say that these unnecessary referrals will not stop—as health minister Chaudhary Lal Singh had desired—in the current state of healthcare system in the state. They give an example to show why they are so pessimistic.
Jameela Bano, five months pregnant, has been “referred” to Lal Ded Hospital from Budgam sub-district hospital.
Jameela said doctors at Budgam hospital told her that her pregnancy is high risk and she should seek expert advice from Lal Ded doctors.
However, her Budgam hospital card reads “patient insists to be referred to LD hospital”.
“She has no complication and doctors could have taken care of her in her in the district hospital,” said a registrar at LD.
Jameela remains mum when asked why she pushed doctors at Budgam to refer her to LD. Her case is typical of patients who have no faith in peripheral healthcare institutions. Others throng city hospitals for various other reasons: the systemic problems that are difficult to tackle.
Shabnam, a pregnant woman from Kupwara, said that on Wednesday she felt her foetus was not moving. She was taken to district hospital Kupwara, where no gynaecologist was available. She came to LD the next morning and vows she will never go to Kupwara hospital again.
“You never know when and at what time of the night they refer you here,” Shabnam said.
Dr Farhat Jabeen, head of a unit at LD, said Shabnam’s case is an “unwanted referral” but they can’t turn away patients because there is no policy that allows them to.
“I would like to know how unnecessary referrals can be stopped,” she said.
The cumulative effect of these referrals is tremendous strain on tertiary care hospitals. It is a common sight to find two pregnant women on a single bed in the crowded labour room at LD.
Jahan Ara is screaming with labour pain on such bed. She has come from Tanghdar, about 130 km from Srinagar. From Tanghdar sub-district hospital, she had been referred to Kupwara sub-district hospital, where doctors advised her to rush to LD because “of non-availability of a bed”.
In May this year alone, of the 500 patients referred to LD from peripheries, only 141 are genuine cases. In June, 155 of the 400 referrals were genuine.
Dr Shahnaz Taing, head of the department of gynaecology at LD, said, “We too are overworked. In LD patients share beds. If we can make such adjustments, why can’t the doctors in peripheries do so?”
“How many times have we seen patients who come from far off places deliver babies on the gates of the hospital ruptures on the gate of the hospital?”
She said unless peripheral centres are strengthened, the hospital will continue to be burdened with patients who do not need to come here in the first place.
“When in the middle of the night you get a patient crying in pain, how can we send her back?”
Besides, as LD medical superintendent Dr Mushtaq Ahmad said, the government is yet to come out with directions on how unnecessary referrals should be stopped.
The situation is no different at the SMHS hospital where, according to Dr Iqbal, a post-graduate posted in the OPD, only about 15 of the 300 patients examined every day on an average need no tertiary care consultation.
“There are patients who come here just because they think doctors prescribe ‘better’ medicines. Minor surgical procedures like removal of appendix can be performed at any sub-district or district hospital but doctors there refer such cases here,” he said.
In May this year, about 850 patients were referred to the SMHS from various peripheral centres. Medical superintendent of the hospital, Dr Nasir Choudhary said that 70 per cent of these were “unjustified referrals”.
“In many instances patients turned violent when we told them they could have been treated at a district hospital,” he added.
He said the health minister should issue guidelines to peripheral hospitals to stop referring patients unnecessarily.
District hospitals have their own reasons. According to medical superintendent of Budgam district hospital Dr Gazala Tabasum, lack of facilities often forces them to refer patients to Srinagar hospitals.
“You need round-the-clock presence of doctors, anesthesiologist, which we don’t have. We have two gynaecologists and two anesthesiologist who are not available after 4pm. How will we do surgeries?”
“If a patient has headache we have to carry out diagnostic tests such as CT scan in some cases. But we don’t have the machine so we refer the patient to Srinagar hospitals,” she said.
The hospital lacks ultrasound machine, a blood bank and facilities to conduct several other tests.
Dr Tabasum said if a patient needs more than one point of blood for transfusion, where will the hospital arrange it in the absence of a blood bank.
She recalls her five years of posting at the LD and how she would get angry at referrals from other places.
“Working at Budgam district hospital showed me how helpless peripheral centres are,” she said.
Another senior gynaecologist, requesting anonymity, said, “No doctor wants to work in peripheries because it is difficult. The government should either send us back to tertiary centres to ease the work of doctors there, or upgrade peripheral.”
Director health services Samir Matoo said the peripheral health care will become strengthened once a new batch of doctors is recruited.
“We are taking stock of our peripheral hospitals. We have told Public Service Commission how many doctors we need and requested them to advertise the posts,” he said.