“ There is nothing new in world except the history you do not know.” – Harry Truman

Zeenat does a “stress test” – checking the ability of major hospitals in the valley against a major fire, followed by the similar report on the state of ventilators in various valley hospitals

(Ms. Zeenat Zeeshan Fazil, 26, was born in Srinagar, Kashmir. She did her schooling from King George (Mumbai) and later Cambridge (New Delhi), and received her Masters degree in English Literature from the University of Kashmir in 2008. Presently, she is also pursuing her second Masters degree in Mass Communications through the Indira Gandhi National Open University (IGNOU). In 1998, she began her career as a freelance journalist with leading national newspapers and simultaneously joined ‘Fazil Kashmiri Publications’ as Editor and Publisher, and is also an editor of the ‘Focus’. Ms. Fazil has written a book on Mass Media and Linguistics (2006), and ‘Falcons of Paradise'(2009), a reference book contains 100 Eminent Personalities of J&K starting from 14th century till date. After working for ‘Daily Etaalat’- a Srinagar based Newspaper in 2007-2008; she joined ‘Daily Kashmir Images’ as a Senior Correspondent by the end of 2008. She is also currently associated with ‘Charkha’, a foundation that highlights the developmental concerns of marginalized section of Kashmiri society particularly in rural areas and to draw out perspectives on women through their writings. Ms. Fazil is also associated with ‘Interchurch Peace Council Netherlands’ which is intensely involved in several conflict areas such as in Kashmir. In 2009, she joined the South Asia Free Media Association (SAFMA). She has received numerous awards for her meritorious contribution in the field of literature. Her interests are reading, writing, poetry, music, travel,and gender related topics.)

Learning Lessons From Kolkata Hospital Inferno

NOT SAFE : VALLEY HOSPITALS LACK FIRE FIGHTING MECHANISM…..

Srinagar: The tragedy at Advanced Medical Research Institute (AMRI), Kolkata, that left more than 90 people dead, most of them patients, has set alarm bells ringing all over the country, Jammu and Kashmir state being no exception.

Though the Chief Minister, Omar Abdullah reacted swiftly asking Home Department to come up with a detailed audit of all the hospitals vis-à-vis fire fighting mechanism, fact of the matter is that almost all hospitals and nursing homes in Kashmir Valley (government run as well as private) are pathetically ill-equipped to meet any challenge.

However, state’s Health Minister, agreeing that there was no proper fire fighting mechanism in place in state’s hospitals, says the issue has been taken up on war-footing basis.

A study carried out by Kashmir Images revealed that almost all the hospitals and nursing homes in the Valley lack any preparedness to meet out any AMRI type tragedy.

SMHS Hospital

One of the old as well as busiest hospitals of the Valley, SMHS has no fire fighting mechanism in place.

Though the hospital has 4-5 emergency exits but when it comes to fire fighting mechanism, it doesn’t exist at all with no sprinklers or smoke detectors in place.

The Deputy Medical Superintendent of SMHS, Dr Shabir Ahmad while talking to Kashmir Images admitted that there was no proper fire fighting mechanism present in the hospital.

“If (God forbid) something untoward happens, besides invaluable human lives we’ll get destroyed expensive equipments like CT scan machines, X Ray machines, Cath Lab’s equipments and all the machinery of OT’s (operation theaters),” he said.

The hospital administration had moved a proposal vis-à-vis fire fighting mechanism to the Principal Government Medical College (GMC), Srinagar some two years back.

“However, we are yet to hear anything from that (GMC) end,” said Dr Shabir.

SKIMS, Soura

Though the this prestigious medical institute has fire fighting mechanism in place but the smoke-detection alarms, hooters and automatic water-sprinklers have outlived their utility. The hospital doctors
Incharge Fire and Security Officer SKIMS, Soura , J. B. Singh agrees that these instruments have become obsolete and says that these would be replaced soon.

“We have around 300 First Aid Fire Fighting Extinguishers of different types including Dry Chemical Powder, Soda Acid, CO2 gases filled in cylinders that have been installed at 48 different spots within the institute (both in wards and hostel buildings),” Singh told Kashmir Images, adding the institute has 122 people looking after both fire and security related issues and all fire escape doors are safe.
Singh revealed that mock drills are conducted once every three months to check whether the mechanism works or not.

“God forbid, if anything untoward happens and the fire is beyond the control of the existing apparatus, SKIMS has a High Magnitude Fire Station within its campus and a proper Disaster Management Program in place,” Singh said.

Psychiatric Diseases Hospital

The only hospital for mental health in the whole of Kashmir, Government Psychiatric Diseases Hospital (GPDH) has no smoke detectors in the entire old hospital building, however, a few rooms of the new building ‘enjoy the luxury’, the survey revealed.

And Dr Mushtaq Margoob, Head of Psychiatry Department confirmed the findings saying though a few fire extinguishers are in place newly under construction building but as far as the old building is concerned, no such system exists et all.

He, however, argues that it is not the fire fighting mechanism that can avert any unforeseen tragedies but ‘active brain behind the set up.’

Quoting an incident of 1996, when fire broke out and entire GPDH was gutted down, Margoob said: “Those days we had no fire fighting mechanism available, but it was the active brain that saved not only our patients but none of them even received a minor scratch.”

JVC, Bemina

Jehlum Valley College (a branch of SKIMS), sources said, has not followed the National Building Code of India, 1980, issued by the Indian Standards Institution that serves as an excellent references to safety management for infrastructures at the time of construction and therefore no fire fighting mechanism exists there at all, the survey revealed.

When contacted, Medical Superintendent, JVC SKIMS, Dr Nasir Ahmed told Kashmir Images that the hospital lacks emergency exits, smoke detectors, fire alarms and water sprinkler.”

“The only mechanism available with us at the moment is some Fire extinguishers,” he said.

However, he added that the new building that was coming up soon, has everything in place as it follows the National Building Code.

G.B Pant Hospital

The sole Pediatric Hospital too presents a dismaying picture as for as fire fighting mechanism is concerned as except Fire Extinguishers, the hospital lacks all other related facilities.

Medical Superintendent of G B Pant, Dr Kaiser Ahmed told Kashmir Images that the hospital lacks the water pipes connected from units to wards; smoke detectors and fire alarms.

“The only thing we have at present to fight fire related incident are Fire Extinguishers,” he said.

District Hospitals

All the hospitals (District as well as Sub District) in north Kashmir’s Baramulla district lack any kind of fire fighting mechanism. The survey revealed that district hospital Baramulla and sub district hospitals in Uri, Sopore, Tangmarg and Pattan lack even the basic fire fighting mechanisms.

Similarly Mirza Mohammad Afzal Beigh hospital in Anantnag has no mechanism available to fight fire except seven fire extinguishers.

Pertinent to mention that the hospital suffered fire incidents in 2003 and 2010 causing huge losses, however, thankfully lives were saved.

Private Hospitals/Nursing Homes

Almost all private hospitals and nursing homes, established in the Valley, lack any sort of firefighting mechanism and some even are running without seeking no objection certificate (NOC) from Fire and Emergency Services, the survey revealed.

“The mechanism doesn’t exist at all. As far as fire extinguishers are concerned they exist only for namesake,” said an expert.

Though none of the people running these private hospitals and nursing homes wanted to comment on the issue, some experts opined that most of these institutions have not followed the building construction code.
“While planning the layout, care should be taken to design the buildings in a manner that there is sufficient open space around to minimize fire spread possibilities from or to neighboring structures. Also there should be enough space for movement and parking of fire fighting vehicles, ambulances, etc. However, in case of private hospitals and nursing homes, nothing of the sort is seen on the ground,” one of the experts said.

Health Minister says

Jammu and Kashmir’s Health Minister, Sham Lal Sharma agrees that no proper fire fighting mechanism existed in most of the government run and private hospitals.

“Yes I too am aware that no proper fire fighting mechanism exists in most of the government and private run hospital,” the Minister told Kashmir Images.

However, he assured that the mechanism would be place in all such institutions within days.

“The other day I had a meeting with Director Health Services and other concerned officers regarding the matter and we have issued advisory to all the hospitals asking them to immediately take preventive measures by installing proper mechanism,” he said, adding he himself will be monitoring the installation process.

Kashmir Hospitals Gasping For Ventilators

Nazir Ganaie (Kashmir Observer)

Srinagar: At a time when the chief minister, Omar Abdullah, and his ministerial colleagues tirelessly claim turning Jammu and Kashmir into a model state, a huge question mark hangs over the critically ailing healthcare services in Kashmir valley, with less than 40 ventilators available for a population of 7 million.

Even after spending billions of rupees on upgrading the state’s healthcare infrastructure, the state government has miserably failed to ensure the availability of the bare minimum life saving machines even at its key hospitals and both in the summer capital as well as in major towns across the valley.

Apart from the prestigious S K Institute of Medical Sciences on the outskirts of the city, half a dozen tertiary hospitals associated with the Government Medical College, believed to be the oldest in the state, are short of the essential ventilators and, more often than not, find themselves hard pressed for saving a patient battling for life.

The valley’s key tertiary care facility, the SKIMS, setup almost three decades ago in 1982 with an objective to spare the patients of expensive treatment outside the state by providing the state-of-the-art healthcare at home, does not have sufficient number of ventilators for the increasing number of critical patients.

“We have 13 ventilators, 12 in the ICU (Intensive Care Unit) and 1 in Isolation Room. All are functional. Primarily, ours is a tertiary care hospital and it has a heavy patient influx every day. I believe we should have more ventilators installed in a proper ICU,” medical superintendent, Dr Syed Amin Tabish, told Kashmir Observer, adding there should be matching and adequately equipped ICUs available.

“Even if we install 30 ventilators, it would not suffice,” the doctor said, stressing that the machine needed additional supporting equipment to make it serve its purpose.

“In Kashmir, there is a great dearth of technical staff to man the ICUs and handle the ventilators. We don’t have enough anesthesiologist, ICU nursing staff, engineers and machines, which add up to a complete ICU. I think we need to focus on these aspects more than anything else to provide quality healthcare,” he said.

During its visit to the associated city hospitals, Kashmir Observer team found the situation quite appalling which puts a huge question mark over the government’s much hyped claims of improved healthcare.

The city’s premier Sri Maharajah Hari Singh Hospital has just nine ventilators installed in a five bedded ICU (Ward No 17). Of these, only one is functional while others, more often than not, remain non-functional for one reason or the other. Nearly 1,000 patients visit its OPD while 850 patients come to Emergency Department daily.

According to doctors, 20 to 30 and sometimes more patients are admitted in each department daily putting tremendous pressures on Ward 17. With long queues outside the ICU, the clamor for ventilators has been increasing over the years. Faced with shortage of ventilators, critical patients are often referred to the SKIMS.

The valley’s only maternity hospital, the Lalla Ded, has five ventilators, mostly donated by various philanthropic non-governmental organizations, for neonates. Of them, only three are working. No ventilators are available for adult females although there has been an upward trend in gynecology-related obstructions. The hospital has to refer such patients to SMHS for being put on ventilators.

Hospital sources said around 11,000 patients visited its OPD monthly and, hundreds of them being admitted. At times, patient admission doubles the intake capacity.

Reliable hospital sources said there was no “proper” ICU and the hospital had only a makeshift room meant for ICU with only a couple of ventilators available for neonates (child patients). “There are no genuine engineers available in the hospital for restoring these ventilators and the hospital authorities have to beg for getting the engineers and still they remain non-functional,” sources said.

“There has to be a separate budget for the ICUs which the Medical Council of India guidelines also prescribe. But the claims of our administrators make it a mockery and all the pressure builds on single ICU room No 17 of SMHS. They are playing with lives of the people for keeping the life saving machines out of order and not increasing their number,” official sources pleading anonymity told Kashmir Observer.

At the premier pediatric healthcare facility, the GB Pant Hospital, half a dozen ventilators are available mostly for neonates.” Save for an occasional snag, all of them remain functional,” HoD and medical superintendent of the hospital, Dr Kaisar Ahmad, told Kashmir Observer.

While the Bone and Joints Hospital has no ventilator, the Chest Diseases Hospital has five ventilators of which only four are functional. And, according to the paramedics, the ICU of the historic healthcare facility had degenerated into a “mockery.”

“It needs to have a highly technical staff, separate ICU nurses, technicians, doctors, anesthesiologists but unfortunately in recent interviews conducted by the Public Service Commission, all the anesthesiologist were dropped and instead MBBS candidates selected, leading to a brain drain with most anesthesiologists leaving for green pastures ,” said an Anesthesiologist on conditions of anonymity.

“Once we feel there is need to put the patient on the ventilators and the machine is not available, we immediately shift him to SMHS or any other associate hospital,” said a senior gynecologist at the LD, wishing anonymity.

“If a ventilator is not available even there, the patient has either to suffer and wait or has to die. This is a genuine need. There has to be sufficient availability of ventilators in the valley hospitals. There has to be specialized ICUs installed with all these machines and manned by required staff, then alone we can provide better patient care,” she said.

“When a huge amount of the budget can be spent on organizing seminars and conferences and furnishing and decorating administrative rooms, why can’t they afford an adequate number of life-saving ventilators,” doctors at the SMHS Hospital asked.

“Go and check the new administrative buildings, you will understand how much money has been spent on their cosmetics. Why can’t they install ventilators in all these hospitals and why can’t they create the required infrastructure for that. All eyes are on Ward 17 of SMHS, which too is in shambles,” they lamented.

The doctors said there was a glaring mismatch even between the hospital beds and ICU beds in most city hospitals, which creates problems for people. “For instance, if a hospital has 100 beds, it necessarily should have two fully equipped and adequately manned ICUs,” they said.

The paramedical staff is no less critical over the inadequacy of infrastructure. “Every day I come to the hospital, I see people struggling for the want of ventilators and I see them dying, when they can’t get it,” said a paramedic wishing anonymity.

“This is very true, sometimes some influential person gets the facility after a single phone call from some high-up, for which I think our hospital administration and government is responsible,” added a senior paramedic in Ward 17 at the SMHS.

Even as the Government Medical College authorities have issued a circular to the heads of all associated hospitals not to brief the press on any matter, the medical superintendent and acting principal, Dr Rafiq Ahmad, said that for installing ventilators, the hospitals needed highly trained technical staff besides other infrastructure.

“This isn’t the question of installing ventilators only, you need a specialized trained staff and it needs a better infrastructure, proper location where it will be installed. We have to develop the ground for installing ventilators. The ventilator does not cost more than Rs 10 lakh but then you have other requirements to match it,” Dr Ahmad said, admitting that the associated hospitals were facing an acute shortage of ventilators.

“Definitely, we have a dearth of ventilators in city hospitals but we have already taken up the issue with the authorities and may get them soon.” he said.

Interestingly, the director of Health Services, Dr Saleem, who controls all the district, sub district hospitals and Primary Health Centers and dispensaries across the valley, said he thought it was “mandatory” to install ventilators with proper ICUs in peripheral hospitals, which could cut down the patient influx to city hospitals. “We are discussing the matter with the government to install ventilators in our hospitals,” the director said.

When contacted, the minister for Heath and Medical Education, RS Chib, said, “We are going to increase the stock of ventilators, the emergency has increased and this has put pressures on already available ventilators.”
“We need to go for more ICUs; the concerned authorities have already informed us about the insufficient availability of ventilators,”.he told Kashmir Observer.

Asked why a large number of the existing ventilators in the associated hospitals were lying defunct, Chib said, “I will find out why these ventilators haven’t been restored so far. I will discuss with the GMC principal and also order an inquiry into it”.

“A new block of super specialty hospital is coming up and we will try to provide space for more ventilators,” Chib said, adding the government would soon approve more ventilators for the city hospitals.