Face-to-Face : Heartbeats of a cardiologist

‘J&K’s healthcare system not up to the mark needs to be loaded with modern infrastructure and supply of essential medicines in hospitals’, says Dr. U. Kaul

Even as the healthcare system in J&K has never been up to the mark, the doctors have been on the forefront to cater to the needs of their patients. However, there are black sheep in the doctors’ fraternity who are giving a bad name to the profession by acting as marketing agents of pharmaceutical companies. This way they are responsible for the distribution of spurious drugs.

In absence of an authentic treatment protocol to COVID-19 infection, the only way to stay safe is to strictly adhere to basic standard operating procedures (SOPs) already rolled out by the world health organization (WHO), which includes, mandatorily wearing a mask, observing social distance, using hand sanitizers, regularly washing hands with soap, etc.

This is what a world-renowned cardiologist Prof Upendra Kaul among other things stated while in conversation with Zia Darakshan, Kashmir Bureau Chief of Arising State. Prof. Kaul has been awarded Padma Shri and Dr. B C Roy Award. He is Chairman Cardiology and Dean Academics and Research, Batra Hospital and Medical Research Center. He finds no scope of medical tourism in Kashmir as has been projected by some experts. Being a son of the soil, he expressed his deep-rooted pain over the way Kashmir’s identity as a special status state was scrapped. Prof. Kaul talked on various issues including the ways and means of fighting COVID infection.

Excerpts of the interview:

Arising State: How do you view the present COVID induced situation in terms of a health emergency at the international, national, and local (J&K) level?

Prof Upendra Kaul: It’s really very bad. Even developed countries are clueless about the coronavirus and continue to struggle to find a treatment protocol to, at least, arrest its spread. You can well understand the severity of this disease that countries like the US, Germany, Italy, Brazil are most affected nations where millions of people have been infected and lakhs of people have succumbed to the disease.

In India, the infection is spreading fast, and ironically, it’s inception in February this year was not taken seriously by the government when cases from Kerala were first reported where the victims had a history of travel from Wuhan, China, which is the originator of coronavirus. Our approach to curb the spread of the infection was piecemeal and in patches. It was all politicized when our prime minister gave unusual calls asking people all over the country to funny acts like clapping and lighting lamps during a particular time. Perhaps he was testing the level of his popularity and faith of people in him. How such acts were going to fight outspread of coronavirus, is still baffling for a sane mind. So this casual attitude of the grave situation, in the beginning, resulted in millions of cases with thousands of deaths, which otherwise could have been, if not avoided but minimized to a large extent.

Now coming to our own region, J&K, especially Kashmir. Since the element of mistrust looms large in the valley and people generally don’t trust the local administration, the spread of infection went unchecked. People here were casual towards the standard operating procedure devised at the WHO level to save yourself from the infection. The level of ignorance induced by the mistrust of people on government operations was to such a level that people here called it a clandestine operation of the Modi government against Kashmiris. So, they defied all SOPs and the result is that the infection has spread fast in Kashmir and hundreds of lives have already been lost to the disease.

It’s interesting that in the downtown area, you see people wearing masks to show it to the police. As the policeman goes away, people remove it.

The influx of migrant labourers which has not been deliberate since this is the time when Kashmiris need them in their paddy fields, brick kilns, etc, too has been the cause of the spread of COVID-19 infection. In Kashmir, we have people who have comorbidities. They have high blood pressure, rampant diabetes. Then there are people with a previous history of heart diseases. Their mortality is high as compared to young people when they get infected with cover infection.

People here have to understand that COVID-19 is a reality with no authentic treatment protocol and it can sweep human lives. There is no alternative but to show the determination of taking preventive measures like wearing a face mask, keeping social distance, using sanitizers etc. These measures alone can help us to stop its spread.  We have to also understand this that people themselves have to make each other aware about the SOPs and it’s not possible for the government to reach every single soul and make them aware of these safety measures. Every one of us has a duty to spread a word about these measures.

Arising State: As we are yet to see a reliable treatment protocol to get rid of the infection, what do you suggest common people stay safe?

Prof Upendra Kaul: There are many drugs that have been tried, but none of the drugs have reduced the death rate. Some drugs like Remidisivir and others have a shortened illness period in mild to moderate symptomatic persons. But the really sick person who has the involvement of lungs on both sides who gets on a ventilator continues to have very high mortality. We were talking a lot about antibodies where we take serum from a COVID survivor and his plasma rich in antibodies is expected to kill the virus. But there are studies that have revealed that administering the convalescent serum is not of great help. So that’s the problem till the time we try to find a well tested and proved vaccine, we have to adopt to preventive measures, which I described in the beginning.

Kashmiris are blessed as everybody here has a house that has at least 3-4 rooms, the family could segregate and not sit in one room. If somebody has COVID, please segregate and leave him in one room. Only one designated person could be taking care of him like giving him food, medicine, etc and that person should be tested once the patient becomes COVID negative. .Testing has become easier and possible on a larger scale. .There are rapid antigen tests where reports are available within one or two hours.

This is a new disease about which we continue to learn more and we are getting new methods of diagnosing it. But unfortunately, any specific treatment which kills the virus and saves the person who has become very sick is still not convincing,

Arising State: Do you agree that the pandemic exposed even most developed nations on health on health infrastructure front? If yes, please explain.

Prof Upendra Kaul: It is very clear the pandemic has its roots in Wuhan and from there the virus travelled to Iran, Europe, Italy, and all neighbouring countries. The mortality rate in these countries was very high. We are very fortunate to have low mortality in our country close to 2.5%. While as they have very high mortality. The reason is that these countries have an average age which is much higher than the average life span of an Indian. Our average age is 69-70 at best. While 89-90 is common in western countries. An octogenarian usually has many comorbidities like diabetes, high blood pressure and then there are patients who have had bypass surgeries, angioplasty,, a kidney disease which lowers their immunity. If and when they get this infection, the mortality is bound to be high. Their mortality is around 10% -15%  and that is the difference between developed countries and developed economies. They are more prone to get complications if infected. with high mortality. In fact, their hospitals have become selective in their efforts to save lives.  If there is a COVID patient of 90 yrs of age with limited ICU beds, they would give preference for the facility to a younger middle-aged person because they have to be more practical in their choice with limited facilities. So it has affected everybody irrespective of religion, caste, socio-economic status. It has gone across to everybody. It’s a big equalizer /leveler.

Arising State: Lets now talk in the context of our own region, J&K. Would you like to describe the position of the health sector? What ails the sector?

Prof Upendra Kaul: I think the health sector here has been putting great efforts,  the professor  Rafiq Jan of  SKIMS has done a wonderful job in treating these patients presenting in large numbers, and then tracking their contacts  I have some colleagues, friends who have been deputed from their regular job as surgeons, physicians in medical colleges to other parts of the valley to track and treat these patients as front line warriors.

Testing which was limited in the initial period has now increased and awareness programs have also been spread far and wide. At airports and other entry points in the valley, it is a  very fool-proof system in place.

I don’t know how much effort the bureaucrats are putting in except projecting numbers. But doctors are doing an excellent job. There is not only COVID, but a lot of people who do not have COVID are also dying. Because we are telling them don’t go to hospitals for smaller illnesses, or you might catch COVID. There are few associations in Srinagar, one is DAK who has formed groups where telemedicine and all the technologies are being used by teleconferencing and you can contact them. The contact numbers are being flashed across so that for any illness you can get to them on a video call and they help. This is a very important development. It is an effort that has to go beyond the govt. It’s for our own protection.

Arising State: Would you like to suggest remedial measures to see our health sector, particularly human saving institutions, rendering services to common people? Where are we lacking on the infrastructure front?

Prof Upendra Kaul: Essential drugs and other kinds of modern facilities are not there in hospitals. Those kinds of things need to be strengthened. This can only happen where local administration is run by locals and who have authority. Unfortunately, we don’t have a local government for one-and-half years now. The administration is full of people who have no idea about these things. They think their main purpose is to see law and order that people don’t agitate, don’t come out on roads to demand Azadi (freedom). They forget about basic things like we don’t have good roads even in the city, electric wires are dangerously hanging because of which we have seen many electrocutions. So the main thing is that there should be local administration and only then such problems can be addressed and measures are taken that it doesn’t happen again. This time proper and modern healthcare infrastructure is grossly lacking. The focus has to be on having basic minimum facilities for prevention of the diseases.

See Kashmiris are very health-conscious people, but they don’t avail health insurance facilities and spend from their own pocket to avail of medical facilities.

As I told you that our hospitals lack infrastructural facilities. Even as we have machines like CT Scanners, etc in our hospitals but they don’t have any backup once a machine develops any fault it becomes out of order. It takes time to get an engineer and spare parts from outside the state and till then patients suffer. The best thing would be to upgrade the health infrastructure and have essential spare parts of such medical equipment in stock for at least a year or so.

Arising State: We have seen a patient-doctor conflict growing over a period of time. Patients are fast losing their trust in doctors. Can you explain to us why it is so? Why has the element of trust patient-doctor relationship gone down considerably? Are doctors to be blamed or do you think patients are on the fault?

Prof Upendra Kaul: Basically business has gone into the heads of everybody – be it a doctor, lawyer, engineer, or any other professional and person in the business. To have more and more facilities at disposal, there emerge some conflicting situations while transacting business or a deal.

However, in general, I don’t agree that there is a patient-doctor conflict. But this is a major problem here in Kashmir. Doctors are also humans. They spend hours tirelessly in hospitals attending patients. Maybe they get irritated after continuously rendering services day and night without a break. But mostly, doctors here are performing their duties just to cure their patients.  Let me assure you that doctors here are trustworthy and I am very proud to be associated with them and training some of them.

Arising State: Doctors are blamed to have become marketing executives of pharma companies. Do you agree?

Prof Upendra Kaul: I don’t think doctors can be separated from other professionals. Humans have become very ambitious and money and power has got into the minds. The pharmaceutical industry like other industries are working towards the goals of increasing their sales.

In order to gain market share, all methods are being used. Sponsoring medical professionals to various cities and countries is a very attractive method of luring doctors. Besides, giving all kinds of incentives is very common. This leads to unnecessary prescriptions, writing drugs of companies that are hardly even known by some. Consumers never ask for a receipt with details of the product, batch number, etc and the trade goes on and on. The regulatory authorities are also very lax in giving permission to market products. Conducting audit and surprise checks of drugs and consumables is rare. This leads to complacency and the ultimate sufferer is the patient.

It is a multi-tiered problem and blaming doctors alone is unjust.

Having said that, I can confidently say that the vast majority of doctors practice medicine very ethically.  It is only a few black sheep who spoil the name of the fraternity, who works tirelessly to save the lives of the sick. One can see the number of deaths of doctors and paramedics during the continuing pandemic of COVID-19 while being the front line warriors.

Arising State: Spurious drugs are a huge menace. Who is responsible for this? How it can be curbed?

Prof Upendra Kaul: It’s not a problem specific to Kashmir because the rules of making and supplying the drugs are so easy that anyone can get a license. Actually the problem lies in regulations. Whatever regulations we have in place to monitor the manufacture of drugs are not actually implemented on the ground. Those with a job to monitor its implementation are not serious in their line of duty. See, what happens. A pharma company manufactures a product and lures chemists with a high margin to sell their product. For example, if a paracetamol tablet has a manufacturing cost of Rs2, the company keeps a margin of Rs.8 to the chemist.  With a high margin, the chemist promotes the product without having any idea of the quality of medicine.

The need is that authorities should make surprise checks of pharmacies and pick drugs at random for testing. It’s a menace that is deep-rooted and needs to be addressed seriously by the government because human lives are directly involved.

Arising State: How do you view the network of private hospitals in J&K?Do they really serve the purpose or have become more commercial institutions?

Prof Upendra Kaul: Private hospitals in the valley have been a problem because of the uncertain political environment. It has not grown. Many healthcare providers who have got a big chain of hospitals in the rest of the country don’t dare to expand their services to the valley. It has a reason. The reason is that turmoil has remained a permanent feature in Kashmir’s daily life. Besides, there is a lack of proper infrastructure in terms of building for a hospital, etc. It’s a big risk for healthcare providers to come to Kashmir and establish a hospital here.

Arising State: Why today’s doctors have lost the clinical ability to diagnose a disease? What are the factors responsible for this ??

Prof Upendra Kaul: The proliferation of a battery of investigations are responsible for this phenomenon. The clinical examination continues to be a very important part of the approach to diagnosis. Machine diagnosis takes away the personal touch which is very important for giving confidence to the patient. Moreover, there is a need to select the test which will be useful in clinching the diagnosis.

The widespread availability of all modern technology-based tests is an issue common to all health care systems. The clinical examination is an appropriate way to screen patients who need to be sent to those high-end centres. Many common illnesses can be treated with a good clinical examination and sophisticated investigations are not needed in general.

Arising State: Do you have any plans to start your own hospital, the field of expertise you have?

Prof Upendra Kaul: If anybody is ready to invest in infrastructure and all, I can render my services.

Arising State: Lastly, would you like to sum up the situation in which Kashmiris have been enveloped? What should be done to pull the place out of the political turmoil?

Prof Upendra Kaul: The political turmoil of Kashmir has become a very complex one. Seventy-two years down the line and several attempts to sort it out have not resulted in any tangible solution. Basically there are many parties interested in keeping the pot boiling. Both the neighbours are also responsible for it. Kashmir had joined with India under exceptional circumstances with an accession but not a merger. The will of Kashmiris has never been ascertained as was promised by no less a person than the First Prime Minister Pt Jawahir Lal Nehru. Jammu Kashmir and Ladakh were never a  part of any country as per the history which many people living in India don’t even know. The special status given to it was slowly diluted and had become just like a fig leaf. The present government in order to fulfill its agenda scrapped it in one go unconstitutionally.  They did everything to humiliate the Kashmiris following 5th August 2019. This they projected as a victory to the rest of the country mainly for getting votes. This has been most unfortunate. History cannot be changed and I am more than confident ultimately we the inhabitants of this valley and surrounding areas will emerge victoriously. We have to remain united and continue to ask our due.

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