Dr. Sonam Dawa, Chief Executive Councillor: The health department of Leh district is one of the most modern and up to date hospital in terms of equipment and facilities for the patients. We can proudly say that SNM hospital Leh is equipped with proper facilities as compared to the rest district hospitals.

In the past, there were fewer facilities in this hospital but today it has been upgraded. But if we talk about the facilities in villages, in some villages there is no medical sub-centre at all and we have been taking up this issue but the thing is that there is no creation of the post for it from the state.

Ten years back when I was in service as a CMO in Health Department, there were 127 health institutions in Leh district but today if we see whether the number of sub-centre rises these has not increased much, this means that the health facilities for the far-flung areas are still not good.

However, if we talk about the health of people in Ladakh being resided in high altitude and clean environment there is less chance of getting communicable diseases. But we see many diseases are growing among the people as compared to the past, the main reason behind these growing diseases is the change in lifestyle, dietary and manners. In addition, today we see lots of junk foods in the market. There is no quality control and supervision of such products which are again the cause of many diseases. 

From the past 10 year, no of a new post has been done by the center and state government due to which most of the demand of the public for Medical Aid Centre remained pending in all districts of J&K. There are more than 500 trained medical students including all categories but due to lack of the creation of posts, they have been stacked. 

A new trend has come up in Ladakh, many people and children take junk foods in the market. Many experts are worried and emphasizing the need to check and avoid the use of junk food.  So it is also the responsibility of parents to keep their children away from junk and packaged foods. The sense of health care, maintaining a proper diet, hygiene, a balanced diet and having knowledge about the preventive measure of diseases is very important which can only be done at an individual level.
  
Equipment and facilities in SNM Hospital, Leh:

We have the have up to date modern sophisticated technology in SNM hospital Leh. Some of the equipment can be compared to equipment available in AIIMs Delhi and there is some equipment which is not there in Safdarjung Hospital Delhi. We have the latest equipment that costs around ₹ 2.50 crore which has been updated during 2016 and 2017. 

The doctors in this hospital are specialists who have experience working with such equipment in many hospitals in Delhi. But if we talk about the manpower, the hospital has been upgraded to 250 beds whereas the manpower remains the same as 150 beds.
 
In summer due to the influx of tourism, the population of Ladakh has doubled which further leads to the problem.

Supply of Medicine:

The medicine in each hospital is being supplied according to the population of a district. However, in Leh due to the influx of tourist in summer, there is a shortage of medicine as it is provided to all the patients whether it is local or non-locals. So in such case, most of the patients have to purchase the medicine from clinics. Keeping in mind the increased workload in hospital and shortage of medicine, we have taken up for additional funds from State Govt.
 
Meanwhile, there is a govt. a scheme that there should be a 24/7 clinic under the premises of the hospital itself called ‘Jan Aushadhi’. It is a scheme that patient can get generic medicine at a lower cost as compared to branded one. Last year we were to install it under SNM hospital but due to the objection of Drug inspector we couldn’t establish it under hospital whereas, we have set it up under Super Bazaar complex, behind the SNM hospital.

Transfer policy: 

In the interest of patient’s care and for a more transparent, accountable and smooth functioning of health institutions especially those located in far-flung areas, recently we have framed a transfer policy. Till today there were no transfer policies at all in the Medical Department.

The transfer policy has been framed on the basis of:

1.     Distance from the original place of residence of individual staffs as per service records

2.    Availability or non-availability of vehicular transport.

3.    Distance to trek on foot to reach the health centre

4.    Topographical and climatic conditions of the place where the health centre is located.

Future Plan:

Medical College is one of the prime demands for the State Government. State Govt. make an agreement with us that in the next year if the centre govt. sanction Medical College to State Govt. Leh will get the first, so hopefully, we will get it soon. If we get medical college in Leh, all kind of facilities will be inbuilt with it and we are no longer demand for separate facilities for each disease. In addition, our doctors and students can get medical education and training from Medical College itself and there is no need to go outside for it.

We have taken up various demands like the creation of post and centre so that we can get proper staff as well as new sub-centre in villages. Presently, there is one District hospital, one sub-district hospital, 14 Primary Health Centers and 24 Sub Centers in Leh district.

We have taken up for up-gradation of Nyoma and Khaltse PHC to SDH and also demanded two sub-centres in a year.
 
Keeping in mind the growing numbers of cancer patients in Ladakh, we have a strong demand to install Cancer Diagnostic Centre in SNM hospital, Leh. We have strongly demanded to install two Trauma Centres, one at Leh-Srinagar road and another at Leh-Manali road. 

It is sad that there are 70 vacant posts of doctor in Leh district. It’s been two years we have been taken up for filling up these posts of doctor.

Solutions:

•    All kind of facilities and demand related to health can be solved at one go if we get Medical College in Ladakh.

•    Post creation is one of the main things which need to be made by State Govt.

•    To maintain good health, the parent should supervise their children to avoid junk foods which are the cause of many diseases.

Motup Dorjay, Medical Superintendent, Leh: Talking about the past and present scenario of disease among the people of Ladakh, if we look back we used to witness many infectious diseases but today we see more lifestyle-related diseases and it is increasing day by day like High Blood Pressure, Diabetes, Heart Attract etc. Such diseases were never heard off in the past years. Ever since the development has taken place, people have completely changed their lifestyle because they have enough money to spend on and that is one the reason they seem more lethargic, so they do not amend themselves to physical work. Nowadays people often use their cars to cover the shorter distance and the eating habits are changing with the coming of packaged foods.

If we compare the Leh hospital from the other district hospitals, the types of equipment needed for the treatment of severe diseases are properly available. There are several programmes run by the Government of India, like programme for AIDS, National Aids Control Programme, in which everything is given free of cost from the time when the patient is diagnosed with the disease, the counselling and the treatment for the same. Likewise in the case of tuberculosis, the patient is given free treatment, for cancer, there is a National Cancer Control Programme, all these programs are in the hospital under different units.

The other programs include National program for Non-Communicable Disease (NCD), National Programs for Health Care of Elderly (NPHCE) for the elderly people above the age of 60, we have a separate ward, physiotherapist and staff to attend them. We even have the programme for the pregnant women called JSY (Janani SuraskshaYojana) and children below six years all of them are getting every facility under National Health Mission. 

To assist the poor patients, the BPL and AAY cardholders have the scheme to get everything on free if they get admitted in the hospital, but they should get the card along with them while getting admit. The patients with TB, Cancer and elderly patients are also getting everything free in the hospital, so the patients should know about it and take benefit from such programme.

However, if we talk about the supply of medicine, indoor patients are getting free medicine. In OPD under Free Drug Policy, patients are providing medicine free of cost. There is another scheme ‘Jan Aushadhi’ in which Generic medicine is available at lower cost. But there is a notion among the people that Generic medicine will not work due to low cost and prefer private clinic/chemist for branded medicine. This notion should be changed among people as Generic medicine works same as branded, but packages are different.

If we have Medical College out here in Leh, there will be more facilities and scope for all. There will be trainees, teachers and conducts researches which help to develop overall health scenario of the region. Talking about the late diagnosis, most of the people of far-flung areas often found to be diagnosed afterward as a severe disease like Cancer, people should consult a doctor for small illness without neglecting because primary care is very important.

If we talk about the training and exposure for the doctors, it has been carried out but today we have got huge technology and machine in the past two years, so hands-on training on these machines is needed for the doctors so that it can be utilized in a more proper way. Now the benefit is that when the doctors from AIIMs comes Ladakh for medical camp, the patients are properly treated and carry out surgery without going to Delhi unlike past years as we have the equipment.

We have laid the foundation for Accident and emergency unit separately in the hospital as it is one of the most important units that have to be there in a district hospital. Till today we have been adjusted within another block. In the coming two years, we will have a separate block for it which can be easy for all emergency related patients that will work for 24/7.

One of the challenges is that we have limited staff in our hospital for sanctioned 150 beds, but we have been looking after 250 bedded patients.  Presently we have 43 doctors 54 nurses and many paramedical doctors.

In winter, we received patients who have to refer outside but due to high airfare some of the patients couldn’t afford to go and we have to manage such serious patient acting as a tertiary centre. We can also get a referral from Kargil district. All these problems can be solved if we get Medical College in Leh. 

There is a need to focus on spreading awareness about preventive measures and updating the knowledge about lifestyle diseases among the people which will be very helpful for people themselves as well as decreased the pressure on hospitals. 

Solutions:
 
• Awareness about the lifestyle diseases and cause of disease need to be spread among the people.

•  Medical College is needed in a place like Ladakh due to the different climatic condition.

•  Vacant post needs to be created and filled.