Tuesday, March 29, 2011

Missing From Health Sector Priorities


A child was killed on the spot last week when a truck, with a reportedly drunk driver on the wheels, ploughed into a group of teenagers on their way to a tuition class. Three of the victim’s friends who were with her at the time were also grievously injured. This transpired in Singtam and the trauma for the injured and their families did not end with the accident; it played on as the children developed complications and had to be moved to “better facilities”. Ambulances were not immediately available, facilities at the hospital inadequate and the desperation levels high.
Drunken driving and accidents are common in Sikkim, and while this is deplorable enough, what is even more galling is the continued failure of the policy-makers and the administrators here to create infrastructure which at least guarantees the best medical attention to accident victims. Hill roads are notoriously accident-prone and the quality of driving here, nightmarishly rash. Then there is the profusion of hydel projects and road and construction sites which inundate the hills, all of which offer only the most rudimentary of safety measures to their workers. The need for safer roads and better working conditions cannot be stressed enough, but in the absence of this being ensured, it becomes extremely necessary that the medical infrastructure is shored up to a level where victims are guaranteed adequate medical attention in the event of an accident.
Apart from road accidents and work-site mishaps, even accidents, like say a fall from a tree or a high footpath, when serious, involves head injuries or other neurological complications. Isn’t it surprising then that the State does not have a Neurosurgeon on its roster of specialists, and even if it were to acquire one, the specialist would not have the infrastructure required for her/him to work? The State has two referral hospitals – the STNM Hospital and the Central Referral Hospital – and yet, when it comes to accidents of any severity, these referral hospitals are used as first-aid centres. Once the patient is stable enough to be moved, families prefer to have them referred out, even to Siliguri, which incidentally, enjoys the services of neurosurgeons. It is ironic that a full-fledged State that Sikkim is, should refer out so many cases even to a sub-division, which Siliguri is to Darjeeling district. The idea behind the CRH was not only to develop the best medical care for the Sikkimese, but with its faculty of specialists and eager-to-learn students, also develop a reputation which would attract patients at least from the immediate region. This has not happened because the nature, and arguably also the quality of service, has been found wanting or is at a mismatch with the kind of facilities required. As for the district hospital at Singtam, this facility was once projected for development as an accident trauma centre, a hospital provided with specialist equipment, and obviously also specialist doctors, to attend to accident cases. It is reasonably central to Sikkim, fed by roads from all over the State, making its location ideal for such a facility. But this project, like many others, was lost to bureaucratic lethargy and short-sighted planning, because no such facility of any reasonable quality is extant there.
What is obviously required for health sector planning in Sikkim is to move beyond iron supplements and health melas. An exclusive accident trauma centre, with the best equipment and personnel will be an initiative worth starting from. Next in line for consideration should be an Oncology department, because this is another conspicuous absence from the list of medical facilities available in Sikkim, a state with a worryingly high prevalence of Cancer cases.

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