Model of Sub district and District hospitals in Jammu and Kashmir Abstract Facilities of Resuscitation:

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1 135 Masoodi I, et al Model of SDH and DH in J&K Physicians Academy December 2010 vol 4 no 12 Model of Sub district and District hospitals in Jammu and Kashmir Ibrahim Masoodi*, MD, DM, Mushtaq Chalkoo, MS, Farooq Qurashi, MS, Abdul Rashid Shah, MD, Charanjit Singh, MD, Fayaz Ahmad Khan, MD, DM, Bilal Ahmad Khan MD, DM. and Hamidullah Wani, MD, DM Abstract: Department of health services hospitals are the most important institutionstaking care of majority of population in developing countries. These hospitals are treating thousands of patients daily. Studies have shown that district health systems, comprising primary health care and first referral hospitals, are key to the delivery of basic health services in developing countries(1). We need to upgrade all sub-district and district hospital so that most of medical and surgical emergencies are taken care in theses hospitals Further in view of AIDS epidemic we need to boost up health education at all levels as we may be encountering large number of cases in near future Keywords: Resuscitation, Preventive medicine programs, cancer surveillance clinics 1) Facilities of Resuscitation: Sick patients usually report to the local hospitals before referral. The Medical Emergency Team (MET) is a newer concept, encompassing a proactive response to a wide range of emergencies with the aim of preventing irreversible organ failure and cardiopulmonary arrest. Daly et al (2) observed in their prospective study that most important common condition leading to Medical emergency team activation were chest pain, cardiopulmonary arrest, seizures and respiratory distress. The authors concluded that application of the MET model to the district general hospital improves the process of patient care (2). We need to upgrade our facilities of diagnosis and management of all emergencies. All hospitals need provision of resuscitative portable trolleys so that patient can be diagnosed to have an arrhythmia, Myocardial infarction etc., by ECG monitor and facilities of defibrillation need to be made available before it is too late for the patient. We should have facilities of endotracheal intubation etc. readily available in all sub-district and district hospitals. Such advanced instruments need provision of emergency drugs like adrenaline, phenytoin, hydrocortisone, calcium gluconate, atropine etc. What the mind doesn't know eyes cannot see. Emphasis should be laid on proper training and updating the training programs in our medical & paramedical staff so that resuscitation is scientific. We must start mandatory basic life support and advanced life support training programs among

2 all our doctors and paramedical staff. 2) Inpatient drug supply: For inpatient service in sub district and district hospitals few drugs are available and these do not cover all or most of aerobic and anaerobic infections.patients in need of higher antibiotics usually require tertiary care. 3) OPD drug supply: Recently a large Anglo-Scandinavian Cardiac Outcomes Trial demonstrated the benefits of antihypertensive treatment (3) in preventing morbidity and mortality Lot of other studies have confirmed the effect of hypertension control on cardio vascular and renal mortality and morbidity We need to focus on antihypertensive clinics and free antihypertensive treatment which should be provided after registration on regular basis because our patients often neglect or underestimate their use. This shall go along way in prevention of cardiovascular and renal diseases etc. in our state. Deworm solutions be provided to children and adults because infections and infestation continue to be important causes of mortality and morbidity especially in far-off villages. Currently available drugs in our hospitals need to be scrutinized by a committee of experts and recommendations for purchase of important and essential drugs should be followed. Sub district and district hospitals need 24 hour emergency medical shops so that all emergency and standard drugs are available to patients round the clock. 4) Up gradation of Ambulances: There is a need that currently available ambulances beupgraded so that they are different from ordinary vehicles because patients pay for this facility. There is a need to have oxygen supply facilities, resuscitation facilities etc., in these ambulances. Trained pharmacist be provided as ambulance boys during transportation of the patient so that they can resuscitate the sick patients during travel. 5) Up gradation of Professional facilities like operation theatres etc: Skills utilization and development are some major areas for improvement. Studies have shown that physicians list high workload, lack of influence on daily work and work processes as dissatisfactory (4). All sub-district and district hospitals have scope of most of specialties provided infrastructure is developed in these hospitals. Operation theatres must be equipped with proper surgical instruments etc. so that emergency surgeries are carried out in a scientific manner. It is very important that our specialist doctors are provided all possible professional facilities and scope for further studies. They should have provisions of attending conference, higher studies so that they all work with enthusiasm and dedication in these hospitals. Studies have shown that stress among physicians is a growing and occupational health concern impacting negatively on patient care (4).

3 6) Up gradation of laboratory facilities & blood banks: Automatic analyzers should be provided at sub district and district level hospitals so that patients get investigated accurately at subsidized rates. Further quality control and maintenance of these instruments needs to be ensured. There is a need that Blood bank facility be developed in all sub district and district hospitals and a proper blood group register made for the needy. 7) Preventive medicine programs: The sub district and district hospital should act as a "base hospital, which are working with the community. It is not separated from the clinics." Put another way, "the focus for the district hospital is not concentrating on the boundaries of your hospital, you go beyond the gate, and you need to go beyond the gate." Worldwide preventive medicine programs are accepted to be cost effective. Emphasis must, be laid on proper vaccination, promotion of health education and antenatal checkups etc. There is a need to start cancer surveillance specialist clinics in these hospitals so that malignancies are detected early in accordance with American Cancer Society guidelines. Comprehensive school Health Programme should be launched in the State so that schools help in promotion of health education in the society. Routine use of iodinated injections in pregnant ladies be carried out in far flung areas where ignorant population continue to use un-iodized salt. 8) Training programs: There is a need to update paramedical staff trainings on regular basis so that patients don't encounter quacks in hospitals. Refresher course packages be provided to them regularly. Special attention should be paid to training of dais, nurses who continue to conduct deliveries in villages. Their training needs to be sufficient so that they can refer complicated pregnant ladies before it becomes disastrous for the mother and the Doctors also should be given refresher training programs regularly preferably in teaching hospitals of the state. 9) Facilities for staff and accountability of work: Hospital employees need to be provided all basic facilities during duty hours especially during night hours. There is a need that a proper record of all patients be made and emphasis laid on the proper working of employees with strict accountability. Improvement in the working and living conditions of health workers is a precondition for the effective delivery of public health services. A multidimensional program of health worker rehabilitation should be developed as the foundation for health service recovery. Direct user fees should be replaced progressively by increased public finance and, where possible, by prepayment schemes based on principles of social health insurance with public subsidization (4). Study from Namibia concluded that the existing level of pure technical and scale

4 inefficiency of the district hospitals is considerably high and may negatively affect the government's initiatives to improve access to quality health care. It was recommended by the authors in this study that the inefficient hospitals learn from their efficient peers so as to improve the overall performance of the health system (5). Last but not the least decentralization is likely to be advantageous in most health systems and we must tread fast towards this goal. References: 1. Segall M et al District health system in a neoliberal world: a review of five key policy areas. Int J Health Plann Manage Oct.-Dec:18 Suppl 1; S Daly FF, Sidney KL, Fatovich DM. et al The Medical Emergency Team (MET): a model for the district general hospital Aust NZJMed.1998 Dec:28(6): Sturkenboom MC, Dieleman JP, Picelli G, Mazzaglia Get al Prevalence and treatment of hypertensive patients with multiple concomitant cardiovascular risk factors in The Netherlands and Italy J Hum Hypertens 2008 Jul31 4. Arnetz BB et al Physicians' view of their work environment and organization Psychother Psychosom 1997:66(3): Zere E, Mbeeli T, Shangula K, Mandlhate C, et al Technical efficiency of district hospitals: evidence from Namibia using data envelopment analysis Cost Eff Resour A lloc 2006 Mar27:4:5 Conflict of Interest: None reported Author Information: Ibrahim Masoodi *MD.DM(Gastro), works in Dept. of Gastroenterology, King Fahad Medical City, Riyadh, KSA; Mushtaq Chalkoo, MS(Surg), as Consultant, Dept. of Surgery, SMHS Hospital, Srinagar, Kashmir, India; Farooq Qurashi, MS(Surg), as Senior Resident, Dept. of Surgery, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India; Abdul Rashid Shah, MD(Med), as Registrar, Dept. of Hematology, Kuwait Cancer Control Centre, Kuwait; Charanjit Singh, MD(Med), as Physician Specialist, District Hospital, Baramulla, Kashmir, India; Fayaz Ahmad Khan, MD, DM(Neuro) as Consultant, Dept. of Medicine, SMHS Hospital, Srinagar, Kashmir; Bilal Ahmad Khan, MD, DM(Gastro); and Hamidullah Wani, MD, DM(Gastro), Dept. of Gastroenterology, KFMC, Riyadh

5 KSA. Address for correspondence: Ibrahim Masoodi, Dept. of Gastroenterology, KFMC, Riyadh, KSA.