Ambulances resembling armoured riot police vans outside Srinagar’s Sher-i-Kashmir Institute of Medical Sciences (SKIMS) are the first indicators that a lot more than health infrastructure needs fixing in the Valley. Despite the fact that reaching a hospital or a healthcare centre is a challenge in the best of times, not just for the sick and ailing patients but also for the doctors treating them, SKIMS is teeming with patients patiently waiting their turn.
Samira Bhat, 39, waits her turn in the oncology ward with husband Noor Mohammad, a carpenter from the Pulwama district of Jammu & Kashmir. Bhat was diagnosed with breast cancer last year, one full year after she first felt the lumps in her chest.
“Stone-pelting and police crackdown that followed in 2010 made it impossible for us to come here for treatment in 2010. I got her here last summer after peace returned,” says Noor Mohammad Bhat.
The fact that the state’s simmering political unrest affects healthcare delivery is obvious from cancer registry data from SKIMS. The institute treated 33,800 cancer patients in 2009, a number which dipped to 28, 399 in 2010, and bounced back to 36,772 in 2011. The numbers of new patients registered for treatment also reflect the street unrest: 2,968 in 2009, 2623 in 2010 and 3057 in 2011.
“In times of conflict, most of the medical staff used these fortified ambulances to reach the hospital,” says Dr Abdul Rashid Lone, additional professor of medical oncology at SKIMS.
Two years of calm have brought tourists back to the valley and patients to the hospitals. So unprecedented is the rush that Dr Sameer Kaul, a cancer surgeon at New Delhi’s Apollo Hospital and personal physician to Kashmir’s Who’s Who, including separatist leader Syed Ali Shah Geelani, has his hands full at the monthly two-day cancer camp he runs at New City Hospital in Srinagar for people who cannot afford to travel out of the Valley for treatment.
He set up Breast Cancer Patients Benefit Foundation (BCPBF) in 2004 to provide free medicine to the poor and subsidise treatment for those who could partly afford to pay.
“We started with breast cancer but soon realised everyone needed help. The cancer prevalence pattern in the Valley is similar to that in Afghanistan, Iran and China, with gastro-intestinal cancers of the oesophagus, stomach and colon being the leading cancers, followed by lung cancer in men and breast cancer in women,” says Dr Kaul.
The high incidence of gastro-esophagal cancers is attributed to the Kashmiri diet high in meats, chillis, dried vegetables with high contamination risk, and scalding hot Noon Chai or salted tea.
When he started holding cancer camps here almost two decades ago, Dr Kaul was often the only passenger on the only plane to Srinagar. “I worked on my own and would get half a dozen patients in a day. Now I have a team of Five doctors that travels from Delhi with me and two oncologist stationed here to treat over 500 patients over two days,” says Kaul. It’s a 16 hour-long working weekend for all seven, “but it’s fun,” says Dr Kaul.
Oncologist Dr Suneem Khan is one of the doctors in Kaul’s team who moved back home to Srinagar in 2009 after doing his MBBS in Europe and working at Delhi’s Apollo Hospital for two years. When he chose to work for cancer patients five years ago, little did he know that he would lose his only son, 17-month old Nauman, to acute myeloid leukemia, a type of blood cancer that starts inside bone marrow that helps form blood cells. Nauman died on September 17, 2011.
“He was diagnosed a day before Eid, on August 30th last year. The only symptoms were fever and bone pain, and a hundred and ten things could have caused that. Though we took him to Delhi, he died within 20 days of diagnosis. People lose their loved ones like this to cancer every day and now I feel even more motivated to do my bit,” says Dr Khan, who spent last weekend in Sopore to screen the villagers for cancer.
Over 90% of patients visiting Kaul’s camp are from villages and are there to get a second opinion. “The personal touch matters, most people want someone to listen and explain things to them. They’re also here because they get treatment 24x7, as we’re all available on our cellphone for follow-up queries,” says Dr Khan. Almost on call, his cell trills as a harried patient asks how to get a blood pressure down. “This is the fifth call from her today, she has a nervous temperament and needs to reconfirm her medication every few hours,” says Khan, disconnecting after rattling off the prescription to her.
“The government needs to re-strategise its healthcare delivery system and audit the benefits of the National Rural Health Mission (NRHM) objectively. If NRHM was delivering even half the services it is meant to people in villages, people wouldn’t be travelling across difficult mountainous terrain to stand all day outside a hospital and wait their turn in the city,” he says.
Is Union health minister Ghulam Nabi Azad listening?