Allopathic Medical System

 

Allopathic Medical System

 Description of the Situation in Zanskar

There is a government health system composed of a network of 22 medical aid centres (MAC)[1] dispatched among the 3 side-valleys of Zanskar and one central Community Health Centre (CHC) in Padum. The system is coordinated by the Block Medical Officer (BMO) – at present moment Dr Jalil – an orthopaedist. There is no private practice in Zanskar.

[1] Akshow, Abran, Skyagam, Athing, Phe, Rhantakshar, Tungri, Sani, Yulzum, Karsha, Tsazar, Zangla, Pidmo, Raru, Pipchar, Itchar, Cha, Testa, Kargiak, Shun, Shaday, Stongday

  MAC (Health Centre) CHC (Central Level Clinic)
Staff Usually 3 staff members: Assistant Nurse Midwife (ANM), pharmacist and superintendent

Karsha MAC: 5 staff incl. a doctor

In remote areas: only 1-2 staff per MAC

1 BMO (orthopaedist)

12 paramedicals

2 NRHM doctors

1 gynaecologist

1 dentist with 2 assistants

1 amchi

 

Infrastructure

(For details cf. Annex 6)

no heating system, water provision through an external water pump, no electricity no heating system, water provision through an external water pump, solar electricity
Rooms 1 room with one or two beds

1 examination room

Labour and Gynaecology Room

Dental Unit

Radiology: X-ray and Ultrasound

Laboratory

Immunization Room

Pharmacy

Sterilization Unit

2 wards with each 10 beds

2 doctor’s Room

Equipment

(Details cf. Annex 6 & 7)

BP machine, stethoscope, use and throw needles, scales, simple dressing material, delivery set Same as MAC plus:

well equipped Dental Unit, gynaecologic and obstetric equipment, dressing and casting equipment, portable cool boxes, fridges

Waste Management and Cleaning One dustbin for all waste (incl. sharp material) One dustbin for all waste (incl. sharp material), waste is put in a hole and burnt, cleaning of the rooms once per day
Patient Flow 1-12 patients/day Physician sees around 50 patients/day
Medicines

(Details cf. Annex 6)

Pain killers, antibiotics, basic gastro-intestinal drugs, basic gynaecologic and obstetric drug, vitamin supplements More or less the same as in MAC

Most given: paracetamol, aspirine, antibiotics

Opening Hours 10 am – 4 pm

Every day except Sunday

10am – 4 pm

Every day except Sunday

always a doctor on night duty and on holidays

Price 2-Rupees outpatient ticket

(cf. Annex 8)

2-Rupees outpatient ticket including doctor visit and medicines

Complementary exams have to be paid additionally (cf. Annex 9)

Additional Information About the MAC

Many MAC staff members work only once or twice per week. Usually, the patients call the staff or visit them in their private houses where the staff also keeps some medicines. They are at the disposal 24h per day.

Usually the allopathic staff and physicians do an anamnesis but nearly no physical examination. The medical care consists of pharmacologic therapy. Some give preventive advice. They rarely explain the disease to the patient.

The MAC staff’s self-perception about their efficiency to cure patients is around 80%, the rest is mainly referred to Padum and rarely to an amchi.

 

Additional Information About the CHC

The two young physicians are sent by the NRHM for a one-year internship. They don’t speak Ladkahi and the local staff translates.

There would be the facility for surgery in the CHC building but still the man force is missing. They try to manage as much as possible conservatively. If this is impossible the causalities are referred to the District Hospital in Kargil or Leh by helicopter or ambulance. It takes at least 2 days to get a helicopter and it takes a one-day ride by car to reach Kargil.

There is no psychiatric care unit so the staff refers mental health patients to Srinagar . It takes two days by car to reach this city.

The dentist reported that, by the help of Italian dentists, he is even better equipped than the dental clinic in Kargil and Leh.

The CMO stated that there should be a segregation of sharp and organic waste. In practice I could not observe this. By giving my feedback, the CMO ensured that he would inform his BMO to take the necessary steps.

If there is shortage of medicine in the CHC Padum, the pharmacist refers to the only private pharmacy of Zanskar that has a broader range of medicines.

The private pharmacist in Padum orders medical products from Srinagar. According to him, it takes one week to come to Zanskar. He sells all the medicines over the counter and is also open in winter.

All the allopathic health staff meets once per month in Padum to get news, to discuss about the problems they face, to get some teaching, to ask for equipment and also to take a stock of medicines and vaccines to the MAC.

 

Prevention Activities

The staff organizes monthly village health days where they usually check the villagers up for sanitation and nutrition problems, give the vaccination and teachings.

These days seem to work only partially. Many staff members, especially the doctors mentioned a lack of time to execute health campaigns but still the CMO states that he gets reports about these village health days. In the immunization unit in the CHC, there are 3 staff members working. They organize one vaccination day per week in Padum and one day per month in the villages with the help of the MAC staff. They give the pentavalent vaccine for free and also hand over a vaccination card to the mothers.

The dental unit staff stated to go to schools every Thursday to teach dental hygiene, distribute brushes and treat dental diseases.

The CMO ensured that soon they would give an eye camera to Zanskar to detect cataract disease. Women and Child issues are discussed in the respective chapter.

 

Training of Allopathic Medical Staff

The CMO stated that the government of India provides generous scholarships to the students and that there shouldn’t be a financial barrier to a health profession study. By asking why there aren’t enough students from Zanskar he replied that they are not coming since they are not interested. A nurse told me that she had to pay her studies herself. She claimed that the training was not well organized and that everybody passed the examinations, which she esteemed as not good.

Every year, there are four seats reserved at Medical University of Jammu and Kashmir for the Zanskari students. These seats are fully sponsored by the Indian government. For several years no new Zanskari doctors have graduated. At present there are two medical students from Zanskar, who got admission in 2012.

The medical staff of Zanskar could also benefit from the help of some NGO to complete their training. During the monthly staff meetings there is usually a teaching and training activity, for example, the most senior midwife teaches all the young nurses about birth giving.