Care Overlooked

Are they institutions that promise to look after you, or simply money minting machines? Syed Asma takes a closer look at the state of nursing homes in Kashmir.

“Congratulations, it is a daughter!” says a nurse handing over the child to Manzoor. He has a big smile; it is his third daughter. Engrossed in the joy of being a father again, he doesn’t ask the nurse about his wife. They will take her out, as they did in the previous two deliveries, he thinks.

“I thought she would be recovering from the effect of anaesthesia,” says Manzoor. He assumed that she was fine, but he was wrong. Neelam, his wife, had excessive blood loss while delivering her baby, and was left with only three pints of haemoglobin. She was struggling every moment; simply to breathe.  

The doctors didn’t bother to convey this information to Manzoor—and they didn’t come out of the operation theatre either. It was after an hour that Manzoor thought he should inquire about Neelam, but couldn’t find anyone. Fortunately, a nurse came out—and her reluctance to talk worried him.

Two hours passed, and Manzoor was still not able to find anything out about his wife. He began to lose his senses, and started shouting. “I thought my civilized approach is leading me nowhere, I began shouting because I thought she is dead and they are not telling me,” he recalls.

Finally, he was told that Neelam has developed some complication, and the doctors are trying their best to treat her. “The doctors didn’t suggest anything to me. I don’t know that man but he was quite old, he told me the hospital has no backup, so I should shift Neelam to some government hospital,” says Manzoor.
Neelam was shifted to Lal Ded hospital, but after observing how critical her condition was, she was shifted again, this time to SMHS. There she was kept on a ventilator. “I am so worried about her condition. It seems no less than a miracle to me to see her alive, after shifting to SHMS she was declared dead twice,” Manzoor says.

Neelam was admitted in a private nursing home for her delivery. She was recommended this hospital by her gynaecologist in her private consultations, as the doctor is a visiting consultant in there.

This has almost become the norm in Kashmir over the years. In private consultations, doctors usually recommend their patients to visit nursing homes that are convenient for the doctors. The patients are then operated upon, unless the individual has the possibility of developing complications that can only be tackled in a well equipped hospital; which in Kashmir implies a government hospital and a few private health centres.

According to her husband, Neelam was quite normal during her pre-natal checkups, and all her medical reports were consistently normal.

But things changed quickly after the delivery. “When we shifted her to Lal Ded and then to SMHS, she was declared dead three times, that is how bad her condition was! She was put on a ventilator for five days. Allah has been grateful to keep her alive. I had left all hopes, seeing her conditions,” says Manzoor.

Neelam is now recovering in Lal Ded, the government maternity hospital.

There have been many cases similar to Neelam’s, with patients have complications in private nursing homes; patients who were later shifted to better equipped hospitals.

Fozia too faced similar complications and went into coma for two months. “Her doctor advised her to get admitted in a private nursing home, but I do not think these centres are worth the prices they charge. They risked my daughter life, they almost killed her,” says Abida.

Before her due date, Fozia stopped sensing her baby in the womb and so she came for a checkup in the nursing home with her doctor. After conducting a few tests, the doctor pronounced the baby dead. “But the doctors did not operate her immediately, they waited. That later became the reason for infection and her bad condition,” says Abida.

The delay in getting her out of operation theatre made her family worried her family. “We shouted, behaved like hooligans and got her out of that hospital. We used all our contacts and shifted her to SKIMS,” says Yasin Ahmed, her brother.

“Doctors in SKIMS told us that she had received infinite internal injuries that had led to internal bleeding,”says Abida.

Both the cases were reported in two different “reputed” nursing homes. But nothing exists in records.

The nursing homes are asked to submit their work done sheet which consists of the list of surgeries and the number of OPDs attended every month. The registered nursing homes in Kashmir have no medical complications recorded with their authorities—the State Directorate of Health—but the reality on the ground paints a different picture.

Why aren’t they recorded at either of these places, if some incidents do exist?

Officials at the Directorate of Health Services say they haven’t come across any cases in the nursing home work sheets where the patients have suffered from complications, and so they have never taken any action. “The patients or their relatives should approach us if they face any complication so that we can take actions,” says an official, “otherwise all is going fine.”

The authorities, feigning ignorance, asked Kashmir Life to share their cases with them, and to convince the relatives of patients to file a complaint with the health services so that action can be taken.

“What will they do? Rather than waiting for us, can’t they cross check on their own, they being the authorities can do anything. They are just not interested in working,” says Abida.

Another case is Tahira, who died due to anaesthesia overdose, according to what her relatives have been told by her gynaecologist. She could not recover from the heavy dose of the anaesthesia given to her, and so she lost her life. She was undergoing a Caesarean.

After this particular case, the nursing home Tahira was in—reportedly one of the reputed ones in the valley—was immediately closed for a few years for “unknown reasons.”

In nursing homes, while operating one finds a surgeon and an anaesthetist and a few nurses, says a resident doctor presently working in a nursing home.
A year ago, Sham Lal Sharma with a team conducted an inspection and came out with a statement in the local press: out of 25 nursing homes in Kashmir valley only five were complying with the norms.

“The government had already given them sufficient time to meet all the norms in terms of providing required facilities to patients. The private hospitals are required to have a two-bed intensive care unit, besides multi-channel monitor, suction apparatus and ventilator. Lack of proper space is another glaring violation,” the Health Minister was quoted as saying.

Aside from a few, none of the nursing homes had a ventilator, one of the basic requirements and by whose absence the complications at times can increase, according to doctors.

The nursing homes are the money minting machines, a fact accepted by the government. The Health Minister with a committee working on checking the rate list and “the results will be out in one or two months,” says Sham Lal Sharma.

“Today most of the deliveries are done by Caesarean because it fetches good money for these centres, even if a patient is ready to go for normal deliveries, she is not encouraged,” says a gynaecologist in SKIMS.

She adds, most of the hysterectomies, removal of uterus, are also conducted in these centres, in most of the cases removal is not needed but they are only concerned about fetching hefty amounts.  Doctors suggest that before going for a hysterectomy, a patient should consult at least two or three doctors, so that she can get varied and valuable opinions.


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