Is coronavirus or migration to blame for Sikkim's struggling health sector?
When a student of Sikkim dreams about becoming a doctor, nurse, technicians, the first thing they do is prepare for entrance exams. According to their ranking post results they leave for studies outside the state and after the completion of courses they opt for out-of-state jobs. This is the story of most medical aspirants in Sikkim.
According to a news report, to complete an MBBS course in India, one has to spend between 15-40 lakhs in five years and that’s just the tuition. If one takes into account expenses for food, lodging and travel, the total is a steep price. Since 70% of Sikkim’s population falls under the rural area with even urban spaces having middle-class families, most of the medical aspirants have to drop the idea of becoming a doctor and opt for an alternative. Although the state government through various scholarship schemes sponsors a few, it is not sufficient.
Unlike Kerala, a Southern state in India which was declared to have the best medical service in India according to a Health Index report, jointly prepared by the World Bank and Niti Aayog in 2019, Kerala has a total of 24 medical colleges including 13 government colleges which provide over 20 medical courses.
Dr Pempa Tshering Bhutia, Director General and Health Secretary opines on the matter. “The infrastructure for the medical college (in Sikkim) is yet to be completed. It’s not a matter of days or week to set up a medical college, but however, for the medical aspirants, we have an MOU signed with the Sikkim Manipal University in which 50% reservation is kept for the local students in which, the cost comes to zero the students who get by are totally exempted from the fee. The following is beneficial for these students who want to build their career as a medical professional but financially they are not able to”.
Aniket* a doctor from South Sikkim adds, “It will be a good improvement in terms of the health sector in Sikkim if a proper medical college is established, especially for STNM as there will be a sufficient number of doctors and interns who can be available 24/7. The numbers of doctors at ground level are very less, it is of need to have at least two doctors in PHCs, if the state has its own medical college then such problems can be tackled.”
“I personally felt the lack of workforce in the health department during the lockdown period, due to lockdown the patient’s number was increased”, says another. The lack in the medical workforce has been amplified due to the COVID-19 pandemic, now becoming an issue of concern for both the health department as well as patients.
Local medical professions who opt to work outside Sikkim cite low remuneration as one of the reasons they migrate. “The salary in our state compared to others are very low which becomes the main factor as to why medical professionals work outside of Sikkim”, says Aniket*.
Sikkim with its population of about 7 lakhs approximately has 147 sub-centres, two CHCs, 24 PHCs, four District hospitals and one central referral hospital and nursing medical college.
Several protests have been seen till date from different NGOs and the people regarding this In 2018 residents of North Sikkim demanded the maintenance of their medical centre since they are fully dependent on PHCs. Despite being the biggest district in Sikkim, the North’s medical facilities are seen as weak. In case of emergency cases like accidents or pregnancies, the nearest medical hub for them is Singtam District hospital.
Similarly, in the year 2019, the foot march by Sikkim Progressive Youth Forum, a non-political body hailing from West Sikkim, walked from Geyzing till the capital, to protest the state’s failure in providing basic medical facility like X-Ray machines, CT Scan equipment and technicians that a district hospital should possess.
Shankar Sharma, a member of Sikkim progressive youth forum SPYF says, “The health sector of Sikkim is pathetic to be termed in one word because in Sikkim especially the projects are sanctioned only to in higher-level hospitals like STNM, and health Centre like PHC, CHC, even district hospital are not taken into consideration. Whereas when we take such health centres into consideration we find that these grass hood level centres are for the common people but due to lack of services from the department people hesitate to visit these hospitals”.
“There is a scarcity of doctors and nurses in district hospitals, due to which doctors cannot give sufficient time to patients at the individual level”, says Sharma. “According to the guidelines of Indian public health standards, there should be sufficient numbers of doctors, nurses and technicians in district hospitals whereas our state is not able to fulfil the needs. For instance, when ultrasonic machines were installed in Geyzing district hospital along with the appointment of a radiologist, it was of no use as when a common citizen goes to a hospital for an ultrasound test, the patient receives dates for the test after 2 months”.
Recently, the government successfully was able to set up an Intensive Care Unit (ICU) ward in Geyzing hospital but Sharma contradicts this move by informing that even though the ICU with 10 beds exists, there is no doctor to operate it.
Adding to this, the outburst of coronavirus crippled health sectors across the world and Sikkim wasn’t far behind. The state’s first case of COVID-19 was registered in the month of May despite all the precautions taken to prevent it and by mid-August, it crossed the 1000 mark.
Sikkim’s sole COVID-19 dedicated hospital was STNM, the largest in the state but even they faced a workforce shortage. The medical staff worked themselves to the bone when cases began piling up week after week - there was no respite from it.
On average, only 40 medical staff are dedicated to COVID-19 per week, including six doctors, but clearly, this wasn’t enough.
“I have done three rounds of COVID duty till date, based on such a massive eye captivating infrastructure of STNM, I sadly say that the workforce is not sufficient,” said a nurse from STNM.
Dr Pemba argues that the shortage of workforce during COVID-19 outburst was not only a phenomenon experienced in Sikkim but other states and nations too. “We were not expecting the virus and it was all of sudden”, he states.
Earlier, in a report by EastMojo Dr Pemba had stated, “There are many places where the doctors and health workers are not sufficient especially in the district hospitals. We have previously pulled in an additional workforce of employees belonging to the Group C and D such as peons and clerks from other departments, to aid us in the health sector and now even government teachers are brought for screening at the borders and quarantine facilities.
But we cannot pull doctors and nurses from other sources, hence we are aiming at the recruitment of more. We want to protect the health workers, as the treatment and services not merely delve on COVID-19 treatment but also non-COVID services, as well. If need be even those in bureaucracy currently, such as myself have to take up our duty as doctors and specialists".
But taking a look at the recent case scenario, the COVID-19 ward of the STNM Hospital which was inaugurated on October 5, 2020, was not functional for a month post-opening. The Director, STNM Col. (Retd) D.N. Bhutia explained, “Once the COVID ward will start functioning, it cannot be interfered with, so we wanted to double ensure the safety of the patients and staff. Before shifting Covid patients inside a whole team has to be prepared beforehand, including nursing staff, technicians and many more due to which it's taking time”.
“The essential needs are also to be kept in mind such as 24-hour water supply, electricity flow and so on, which is being managed and it will take 3 to 4 days more after which we will shift the Covid patients and the ward will function fully”, concluded the Director.
A staff nurse from West Sikkim PHC Said, “I have been working as a staff nurse since last few months and I came to realize that the health care sector in Sikkim still lacks in various area like staff shortage, with no well-equipped modern facilities in CHC and PHCs.
“Talking about the problems faced by the hospital as well as the people in rural areas are first, that I would like to mention here is poor transportation facilities and the second lack of education among the people of the community. I am being honest here. Health care sector of Sikkim lacks in terms of the workforce because the government does not create posts even when they know there is a dearth of medical professionals.
She continues, “Most of the doctors and nurses choose to work out of Sikkim because our state does not have the facilities that we see in other states. We are professionals, we want to upgrade our knowledge. Our job is all about practice and to be honest, the more we work in a well-equipped place the more we get to knowledge and I think the government should implement Inservice education policy in each and every hospital so that we get to improve according to the generation, on an everyday basis the technology is been improving and the nurses those how are working are deprived of it.”
STNM Multi-specialty hospital is one of the major government hospitals of Sikkim, which provides free treatment to its local citizens but despite the hospital claiming to be multi-speciality, it is not able to provide an end line treatment which usually is provided by such hospitals.
“During 2008-2016 there was no regular appointment of doctors and medical staffs leading to a shortage in health professionals but now when we look into stats form 2018 till 2020 we have recruited 500 nurses, the ongoing recruitment of technicians, 40+ recruitment of doctors and the recent recruitment of 2 super specialist neurosurgeon,” says Dr Pempa.
However, it is important to mention certain improvements that cannot be overlooked in Sikkim’s health sector. For instance, two neurosurgeons were appointed at STNM Hospital and their first-ever neurosurgery was conducted in STNM hospital on November 28, 2020, was a successful one. The surgery was performed by Dr Pranav Rai along with anaesthetist’s Dr Nilima, Dr Kinga and OT staff on a 61-year-old patient.
Likewise, at Geyzing hospital gastroenterologists conducted gastrointestinal endoscopy and band ligations of oesophagal varices for the first time.
Dr Pempa informs that the department is also trying to set up a testing Centre at old STNM so that it becomes easier for citizens to test for COVID-19.
“The war is yet to be won, the vaccine has not been formulated till now, meanwhile people should follow SOPs, take precautions and stay at home and avoid crowds as much as possible. Further, to prevent COVID-19 not only health professionals but regular people should also become more aware - if any symptoms are felt, get tested immediately”, appeals Dr Pempa.
By Sherab Palden Bhutia. The author is a freelance writer. He can be contacted at firstname.lastname@example.org.
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