Q. Could you share a bit about your background and your journey in the healthcare sector?

Jullay! I'm Dr. Rinchen Chosdol, and my career in the healthcare field spans over 23 fulfilling years. My journey commenced upon earning my MBBS degree from Medical College Jammu. Since then, I've been dedicated to serving communities in diverse and challenging settings.

My professional path has taken me through various remote and underserved areas, including Chushul, Tangtse, Khaltse, Nyoma, and Sham block.  I've held significant positions, including Block Medical Officer in Khaltse and Leh, where I actively contributed to enhancing healthcare provisions and addressing community health concerns.

Presently, I have the privilege of serving as the Medical Superintendent at SNM Hospital Leh. In this role, I oversee and coordinate medical services, ensuring the delivery of compassionate, comprehensive, and efficient healthcare to our community.

Q. Could you provide an overview of the services and capacity offered at SNM Hospital, given its significance as the primary healthcare center in Leh?

SNM Hospital Leh stands as a pivotal healthcare center within the UT, offering comprehensive services and surpassing typical district hospital standards across the nation. This hospital serves as a crucial referral point, both for incoming and outgoing patient transfers. Its infrastructure and range of services exceed the typical capacity of a district hospital, making it a preferred choice for patients not only from within the district but also from distant areas like Zanskar.

Unlike most district hospitals limited to consultant-level care in areas like general surgery, gynecology, ENT surgery, and internal medicine, SNM Hospital offers an extended spectrum of super-specialty services including urology, orthopedics, and surgical. The hospital facilitates day care chemotherapy sessions regularly for cancer patients. Also, facilities like Hemodialysis of 18 to 20 renal failure patients regularly twice or thrice a week depending on needs basis going on in the hospital all free of cost under the Pradhan Mantri Jan Arogya Yojana( golden card)

Recently, SNM Hospital implemented a significant change by offering free diagnostics such as blood tests, X-rays, CT scans, MRIs, DEXA scans, FibroScan, Colposcopy, and mammography. Previously limited to older adults and pregnant women, these services are now universally accessible at no cost or on a refundable basis to the entire public through health IDs under PMJAY.

The Orthopedic department at SNM Hospital stands out for its exceptional performance, conducting successful surgeries—a distinction not commonly observed in other district hospitals.
Additionally, the hospital facilitates the benefits of the Golden card, enabling individuals to avail themselves of these privileges from the date of admission and continuing even when referred outside the UT. This accessibility to advanced healthcare services and the comprehensive range of facilities position SNM Hospital Leh as a pivotal healthcare provider not just within the district but on a larger regional scale.

Q. Is there adequate manpower at SNM Hospital, and what challenges does the administration face in this regard?

Manpower shortages have persistently challenged SNM Hospital's operations, particularly in the availability of doctors. Following the transition to a Union Territory, recruitment drives through NHM and outsourcing attempts helped alleviate some of these shortages. Originally sanctioned for 240 beds, the hospital now accommodates 323 beds, though the manpower hasn't scaled proportionately.

During summers, the population surge intensifies patient numbers, straining resources. This influx includes tourists, labourers, and para-military personnel. Government norms mandate a geriatric ward in every hospital, and while we have established one, the challenge lies in the absence of a specialized medical practitioner or physician dedicated solely to this ward's needs.

Operating departments like X-ray and emergency services run round the clock, demanding substantial manpower. My experience as a casualty medical officer involved managing heavy workloads for 18 hours, particularly overwhelming during summers due to the surge in patient volumes. This underscores the urgent need for increased manpower to address emergencies promptly.
In standard setups, ICUs necessitate a larger staff presence for continuous monitoring. Unfortunately, we face shortages in critical positions such as intensivists for specialized care and anesthesiologists for consistent coverage, with no recent creation of these roles. Additionally, there is a deficit in the number of nurses required to meet ICU standards. Enhancing our ICU setup with adequate manpower could significantly reduce the need for external referrals from Leh. Moreover, shortages in Medical Officers for emergencies, OPDs, and consultants create additional strain. Duty protocols with VIPs exacerbate doctor shortages during such events, exacerbating the hospital's burden.

Lacking super-specialty departments like oncology and gastroenterology, SNM refers numerous patients outside Ladakh, reflecting the need for these specialized services within the hospital.
This response highlights the persistent manpower challenges and their impact on various departments within the hospital, emphasizing the urgent need for additional specialized staff to enhance healthcare services. 

Q. Are there sufficient facilities available to transport emergency patients to other cities when required?

Patient transportation from SNM Hospital to other cities depends on various factors and patient categories. For instance:
a)    For injured tourists needing immediate treatment, time constraints often prevail, even if our facilities could accommodate their care.
b)    Pregnant women and infants requiring specialized or intensive care are promptly referred out under 'fit to fly' conditions for their well-being.
c)    Emergency cases like accidents, strokes, head injuries, and severe chest traumas are carefully evaluated. If further treatment is necessary, patients are referred out; otherwise, we strive to provide on-site treatment.
We face significant challenges due to the absence of a fully equipped critical care ambulance capable of providing incubation facilities (artificial breathing support) for patients in critical conditions. The timely transport of patients becomes critical, as the 'golden hour' is crucial for their survival in such critical conditions, especially when long road journeys are not feasible.
Unfortunately, the lack of a well-equipped helicopter or air ambulance further compounds this issue. While the Air Force and Army occasionally assist with air ambulance facilities, not all critical patients are transferable via these means. Winter conditions amplify difficulties in road transportation, warranting the urgent need for an air ambulance or a fully equipped, ventilated helicopter. Although we offer free-of-cost ambulance services for road transportation, including critical care and eco ambulances, the multifunctional nature of these vehicles poses limitations.

Efforts have been made to request additional ambulances and hearse vehicles from higher authorities to ensure adequate transportation facilities for referral patients and respectful handling of deceased individuals.

Q. How crucial is the establishment of a medical college in Ladakh, and what role can it play in enhancing the health system?

The establishment of a medical college in Ladakh holds immense significance, but its effectiveness relies heavily on ensuring a sustainable presence of quality healthcare professionals within the region. While setting up infrastructure is feasible with adequate funding, the pivotal aspect lies in having a permanent and skilled workforce.
The transient nature of temporarily hired staff, especially during times like the pandemic, has posed challenges. Despite the high recruitment numbers via NHM and outsourcing, many healthcare professionals, after receiving training and experience, opt for better opportunities or leave due to various reasons.

For a medical college to fulfill its potential, it needs to be fully operational with a substantial and consistent workforce. Such institutions bring super-specialty expertise that plays a pivotal role in elevating the overall health system.

Q. Talking about public health issues, we have witnessed that many of the patients are diagnosed late when referred to a big hospital outside states. What is the reason behind and how it can be curbed?

Late diagnosis among referral patients, particularly cancer cases, often stems from inadequate awareness about various illnesses and neglected food habits. There's been a shift from deadly communicable diseases to more prevalent non-communicable diseases (NCDs), highlighting the need for enhanced preventive measures.

The Arogya Mandir in Ladakh has significantly improved post-UT, showcasing progress in manpower, facilities, infrastructure, and community-based programs. These centers play a vital role in screening NCDs, emphasizing their preventable nature.
 
However, challenges persist due to patients' impatience with waiting times, a systemic issue despite the introduction of ABHA or Golden cards. Additionally, many patients fail to return for prescribed tests, indicating a lack of awareness and neglect toward their health, dietary habits, and lifestyle choices.

Common practices like consuming leftovers, opting for outside meals, and reliance on preserved or packaged foods contribute to health issues like stomach cancer. The shift toward a sedentary lifestyle, minimal physical activity, and the decline in traditional farming practices further exacerbate these health concerns.

Encouraging regular health check-ups, emphasizing the importance of follow-up tests, and promoting self-examination for illnesses like breast and oral cancer can aid in early detection. Establishing a continuum of care, from Primary Health Centers to District Hospitals and beyond, ensures a systematic approach to tracking, following up, and referring cancer patients as needed.

Q. What are the plans and measures of SNM hospital to ensure better health facilities?

Leh, being an isolated region, requires a strategically equipped hospital. However, the sanctioned strength of the hospital hasn't matched the growing requirements, necessitating increased government prioritization. Initiatives include requisitioning a Cath lab, developing a Microbiology lab, and a cardiology setup.
Critical steps for enhancing future healthcare involve regular post-creation and the inclusion of a Neuro Surgeon for emergencies, complemented by a Neurology setup. These measures aim to reduce patient referrals outside the region and improve comprehensive care within SNM hospitals.

Message to the readers
“Let's prioritize our health by taking proactive steps to address detrimental habits like smoking, excessive alcohol consumption, leading a sedentary lifestyle, and adopting unhealthy eating habits to prevent diseases. Support teens facing mental health issues without judgment. Parents focus on children and spend quality time with them. Together, through compassion, understanding, and active participation, we can contribute to healthier lifestyles and brighter futures for ourselves and the younger generations.”