Charges of medical apathy, ailing infrastructure amid COVID in Kashmir

As the COVID-19 pandemic is pushing the global economy towards recession and threatens to alter geopolitics, the tiny virus is also testing the limits of delicate healthcare infrastructure in the restive Jammu and Kashmir, where the doctor-patient relationship, at present, is facing a crisis of sorts.

Several videos from various hospitals show excruciatingly painful ordeals and anecdotal evidence of alleged medical negligence and apathy. On the contrary, the doctors complain that they are being “unfairly targeted” for the administrative loopholes and the ailing healthcare infrastructure in place.

Obviously then, the situation remains precarious as the COVID-19 infection curve continues to follow an upward trajectory.

On July 20, J&K reported 751 new COVID-19 infections and 10 related deaths. According to the J&K administration’s media bulletin, the number of positive Covid-19 cases is touching the 15,000-mark (14,650) while 262 individuals have died; 234 of those in Kashmir alone. Most positive cases and deaths are from the Kashmir Valley. Till now, 8,274 patients have recovered and 6,122 are active cases.

Ghulam Ahmad Beigh, 65, a fairly-known businessman, was one the recent individuals to have died due to the disease in summer capital Srinagar. Basit Beigh, son of the deceased, alleged that his father died due to “medical negligence” and “apathy” at the Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Bemina in Srinagar.

However, doctors refuted the allegations as “baseless.”

Ghulam Beigh, according to his son, was suffering from hypoxia (a medical condition in which the body or a region of the human body is deprived of sufficient oxygen supply at the tissue level) and, therefore, was receiving medical attention at home in consultation with a family doctor. Speaking to The Federal, Basit alleged, “My father died due to medical negligence. He was reluctant to visit any hospital due to the current coronavirus crisis.”

According to Basit, his father was isolated immediately after he had fever and his oxygen saturation levels were continuously monitored. After signs of recovery, Basit said that the family got the patient’s CT scan and MRI done at a private laboratory. Thereafter, he was also tested for Covid-19 at Srinagar’s Shri Maharaja Hari Singh Hospital (SMHS) as per the protocol. He tested positive.

Related news: J&K opens for tourism, pilgrimage but locked down for locals

As the condition of the patient deteriorated and oxygen levels went down, Basit immediately shifted him to the nearby SKIMS hospital in Bemina, locally known as the Jhelum Valley Medical College (JVC). “My father was on oxygen support. We faced tremendous hardship in getting him admitted at the designated Covid hospital,” he said, alleging that “the Chief Medical Officer (CMO) there flatly refused to admit my father.”

Basit tried explaining to the CMO that his father was suffering from hypoxia, to which the latter allegedly responded: “So what? What will I do?” However, after some phone calls, the patient was finally admitted.

The Federal reached out to Dr. Shafa Deva, Medical Superintendent, SKIMS hospital, who denied the allegations levelled by Basit. “The extremely critical patient was gasping for breath. The protocol is to admit patients only with a proper referral, but in this case we admitted him on seeing his critical condition,” Dr. Shafa Deva told The Federal, adding that “the concerned family had delayed the patient’s treatment for Covid pneumonia. The patient was already on oxygen support when he was brought to the hospital. We supplied him with high-flow oxygen, but his condition was critical on arrival.”

However, Basit said that he feared, “The doctors took his oxygen off in order to take him to the washroom that resulted in further fall of SP02 levels, and he died of hypoxia on his way to the washroom. How can they take the patient off oxygen?”

“My father died due to negligence of the doctors of JVC Srinagar. He was Covid-19 positive. Imagine the plight of my late father that the patient in the next bed called me and said ‘your father has to urinate and no one is taking him’,” Basit said.

“They (the hospital authorities) don’t allow attendants inside. I called the on-duty doctor who further told me that they’re taking my father to the washroom. He was on high flow oxygen with a declining SP02 level,” said the son of the deceased.

Related news: Kashmir’s quarantine policy needs a revisit, say experts

Dr. Mudasir Firdosi, a Kashmiri doctor based in the United Kingdom, said that as per the Standard Operating Procedure, attendants are not allowed inside Covid wards. “But in a place like Kashmir, where attendants do most of the nursing for the patients, how will this work?” Dr. Mudasir argued in a co-authored article.

Speaking to The Federal, Dr. Firdosi concurred that “in Kashmir, medical negligence is not so uncommon.” But he said that “even the best healthcare systems around the world have failed to cope with Covid-19. Doctors too are human beings and they can break down too.”

Dr. Firdosi has done his MBBS from ASCOMS, Jammu and MD from Srinagar’s Government Medical College (GMC). He later did specialisation in psychiatry at the prestigious King’s College, London. He apprehends that “the doctor-patient and public relationship could turn worse since the situation won’t improve soon and sadly, many more will die as this illness is still not treatable.” He said that doctors are at a higher risk of catching the infection and can be carriers of the virus for their own families as well.

The situation in Kashmir has already shown signs of a deteriorating relationship between doctors and patients. In several acts of hooliganism at the SMHS hospital and its super-speciality wing, several post-graduate resident doctors, including Dr. Mahapara, Dr. Abeer, Dr. Imran and Dr. Asif, were assaulted by angry attendants on charges of “medical negligence.”

The Doctors Association of Kashmir (DAK) issued a statement to condemn the manhandling of a few resident doctors. “It is sad that we have to fight Covid-19 on one side and defend ourselves from the unruly mob on the other,” said Dr. Suhail Naik, consultant paediatrician and DAK president. Dr. Naik said that the doctors were trying their best to deliver their professional services with very limited resources and the poor infrastructure available. “People must understand that some administrative issues are not in our hands. They should support us in our collective fight against the pandemic.”

After the assault on a few colleagues, the resident doctors at the SMHS went on a strike, leaving many critical patients unattended. Several attendants shot videos to highlight the apathy and asked how the emergency wards could be closed. The rooms of the medical superintendent, the chief medical officer and laboratory technicians too were seen closed due to the strike.

Related news: New Unlock 2 guidelines issued in Jammu & Kashmir

The situation in Kashmir is not black and white; there are many shades of grey. There are many first person accounts that allege medical negligence with evidence. Journalist Umar Mukhtar wrote a first person account in the Srinagar-based weekly Kashmir Life of his uncle’s death who, according to the reporter, was denied first aid.

Mohammad Yousuf, Umar’s uncle who was a physical education teacher at a private school, had complained of severe chest pain on July 17. Umar drove him to a hospital in south Kashmir’s Pulwama district for treatment. “In excruciating pain and breathlessness, he could not bear the mandatory mask on his face,” Umar wrote, adding that, “The lone lady doctor available at the casualty ward of the hospital was wearing half protective gear and she did not let my uncle come inside the room. She asked him to put his mask first.”

“I cannot risk my family and children for your treatment. I am a mother first, then a doctor. They are my priority, not patients,” Umar quoted the lady doctor as having said.

Umar put a mask on his uncle’s face even as he struggled with breathlessness. The patient was detected positive after a trop-T test, indicating heart failure based on his symptoms. He was then referred to Srinagar’s SMHS. It took them 45 minutes to reach there, but to their utter disappointment, the doctors there had gone on a strike.

Sensing that his uncle might have lost the golden hour already, Umar pleaded with the ambulance driver who only reluctantly agreed to take the patient to the SKIMS, Soura. The driver had first allegedly refused to take the patient there. Umar lost his uncle at SKIMS on July 18. “Was I an incompetent nephew or the system is so competent that it issues death certificates faster than the first aid. I do not have an answer,” he concluded.

Related news: Except two districts, all of Kashmir declared red zone, cases cross 4,000

Umar’s uncle is survived by four children, three of them daughters.

In one of the video statements, an attendant alleged that after losing a member of the family, the authorities at the SMHS were neither handing over the body in a casket nor giving the Covid result of the deceased, despite waiting for 24 hours. Others alleged that the dignity of the dead was being snatched and even a dignified burial was being denied due to indifference.

Dr. Masood Rashid, anaesthesiologist and intensivist, said that the people must understand that “both asymptomatic and symptomatic cases are increasing at a galloping pace. The health infrastructure is the same except for the fact that some hospitals have been converted into Covid-level hospitals. But moderate to severe patients cannot be treated at such facilities,” he told The Federal, adding that “we need station or hospital ventilators, transport ventilators and high-flow oxygen systems for the patients. More infections would mean that our limited facilities will get exhausted. New hospitals need to be added.”

Furthermore, Dr Masood said that when people lose their loved ones it is natural for them to get emotional, but “complications cannot be labelled as medical negligence. Negligence is a punishable offence.”

Dr. Muhammad Salim Khan, professor and head of department, community medicine at GMC Srinagar, has advised people to strictly follow precautionary measures. “If one has fever, sore throat, breathlessness with decreasing oxygen saturation (90 per cent on oximeter) and X-Ray/CT scan features suggestive of COVID, despite negative or awaited test result, it could be Covid-19. Isolate yourself, wear mask and seek medical attention,” he said.