In 2011, I rejoined the Directorate of Health Services Kashmir (DHSK) after two decades in Government Medical College Srinagar including a stint as an International Visiting Fellow at Harvard Medical University (MGH, Boston). I was given the dual responsibility of reviving the defunct Kashmir Nursing Home as Medical Superintendent, and the open-ended task of conceptualizing and implementing healthcare reforms and innovations as Member-Secretary of the newly formed K-RICH committee (Kashmir Reforms & Innovations Committee for Healthcare).

SDH Pahalgam Concept

Fortunately, my team members were two energetic and dedicated young doctors who had recently been trained in Public Health at the National Institute of Health and Family Welfare, New Delhi. The personalities of Dr Niyaz Jan and Dr Arshad Rafi could not be more different, but between the three of us we came up with a series of health reforms and innovations that have transformed the face of health care delivery in Kashmir.

Our initial focus was on logical manpower placement. I was astonished to learn that super-specialists were languishing in the field without the necessary resources to utilise their skills– for example, an onco-surgery specialist was posted in a remote area of Kupwara without access to an operating theatre. Immediately we conceived the idea of conducting SuperSpecialist Outreach Clinics (SSOC) at Kashmir Nursing Home where super-specialist doctors from the field could utilize their training and skills in a favourable environment. OPDs were started in Cardiology, Gastroenterology, Endocrinology, Urology, Plastic Surgery, Orthopaedics, Pediatrics & Pediatric Surgery, Haematology and other super-specialties.

By the time Kashmir Nursing Home was taken over by Government Medical College Srinagar in 2013, upto 200 patients per day were being provided super-specialist consultation and the total patients treated ran into tens of thousands. Thousands of Day Care Surgery procedures had been conducted along with hundreds of endoscopies. Numerous free testing camps including BMD, Lipid and Diabetes testing camps had been conducted along with Patient Awareness Camps for lifestyle diseases. Regular Basic Life Saving (BLS) training sessions and Blood Donation Camps were held and hundreds of blood units collected.

The K-RICH team introduced BLS (Basic Life Support) training in collaboration with the International Committee of the Red Cross (ICRC). A core team of BLS Trainers was trained by Dr Eric Bernes, world-renowned expert from International Committee of the Red Cross (ICRC). These trainers in turn have provided BLS training to almost 5000 health employees in a phased manner. Photo/Video Journalists and drivers belonging to health services were also trained in BLS as they are often the first on the scene of an emergency and plans were developed to focus on BLS trainings for students and police personnel.

Advanced Human Simulator at RIHFW

A bottleneck in optimal healthcare delivery was found to be the lack of adequately trained paramedics in Kashmir. K-RICH developed and implemented a state-of-the-art Patient Simulation Laboratory at RIHFW Dhobiwan with the advice of Dr Kanav Kahol from the Public Health Foundation of India (PHFI). This in-house innovation of the first Patient Simulation Lab in the public health sector in India is enabling students, paramedics and doctors to learn, practice, and repeat procedures as often as necessary in order to correct mistakes and refine their skills without compromising the safety of real patients. Dr Manzoor Kadri, the proactive Principal of RIHFW, helped us to develop a schedule for weekly training of doctors and paramedics from district institutions under his direct supervision so as to maximize benefits of the SimLab.

Another area where we benefited from the wide experience of Dr Manzoor Kadri was the revival of academic activities including publication of the Indian Journal for the Practising Doctor (IJPD), the indexed peer-reviewed journal of the Directorate of Health Services, besides Kashmir Healthline, a quarterly newsletter and an annual comprehensive performance review book. An eye-catching calendar showcasing the achievements of the Directorate has also been introduced from the past two years.

During a meeting with the Asia Head of the International Committee of the Red Cross (ICRC) to review our progress and to explore further avenues of collaboration, I requested the ICRC to arrange ATLS trainings for our specialists. Since we had set exacting international standards for the JKATS EMS project, I also requested the ICRC to share their experience in ER development so that the same level of care would be maintained once the patient was transferred from the JKATS ambulances to our hospitals.

In 2013, twenty trainers of the Directorate were trained in ERTC (ATLS) by master trainers from the ICRC in April 2013. Meanwhile the Directorate constituted its own ER development team which is setting up modern fully-equipped Emergency Rooms in hospitals in the field. This team is doing a fantastic job and hopefully the ICRC will help with targeted trainings in modern ER concepts.

InterPLAST Reconstructive Surgery Workshop in Kashmir

Another collaborative effort achieved by K-RICH was a joint Reconstructive Surgery Workshop with InterPLAST-Germany. A plastic surgery team from Germany headed by Dr. Andreas Schmidt and assisted by specialists from DHSK conducted free reconstructive surgeries during which 80 patients of cleft deformities, burn injuries and other functional disabilities were operated upon. Two hundred more patients were registered for subsequent camps.

In 2013, I was appointed as Nodal Officer for DHSK for the Amarnath Pilgrimage. Dr Niyaz Jan had left for the USA to pursue Masters in Public Health, but with the assistance of Dr Arshad Rafi , we developed an Active Health Management Manual for pilgrimages and similar events. Health facilities were drastically overhauled and the event was micro-planned to such a level that there was a drastic reduction in Yatra deaths this year.

Another perplexing state-of-affairs was the manner in which new hospitals were being constructed in J&K. Agencies like PWD, JKPCC etc were being handed over enormous amounts of money and land to build hospitals in any manner they pleased. Facilities were being planned in a haphazard manner, and building vertically to reduce the footprint while conserving available land was an alien concept. Major hospitals had been in the pipeline for decades without being commissioned, and those few that had been completed lacked major facilities like patient lifts and ramps.

District Hospital under construction at Kargil

The K-RICH team did an intensive study of international and national hospital standards as well as relevant codes like the National Building Code. Based on these principles we designed a series of prototype DH, CHC and PHC designs wherein latest hospital concepts as well as disaster management and patient accessibility standards were incorporated. Major Hospitals like District Hospitals of Bandipora, Kargil, Sub- District Hospitals at Pahalgam and Tangmarg, Trauma Hospital at Bijbehara, Primary Health Centres at Quimoh, Kalamchakla, Chanapora, and numerous other health institutions are being constructed on prototype designs developed by K-RICH. We also redesigned a number of existing or under-construction hospitals to become more standards-compliant and user-friendly with the addition of ramps, wheelchair access, sub-waiting spaces, additional toilets and attendant facilities.

As Nodal Officer for NABH (National Board for Accreditation of Hospitals) Project efforts were initiated for getting selected hospitals of the health department accredited by NABH. Proposals for Colour-coded aprons and QR-Code based ID Cards were introduced as well as Biometric employee attendance systems with remote surveillance.

With the transfer of Kashmir Nursing Home to the Medical Education department, we shifted the Super-Specialist Outreach Clinics (SSOC) to the underutilized Mini Maternity Centre (MMC) at Zakura to provide the population of the underserved area with advanced healthcare facilities at their doorstep. Specialist Outreach camps are being held at district level in collaboration with NGO’s like Zakat Trust etc.

(To be concluded)

Link: Newspaper version in Greater Kashmir