When the Nipah virus outbreak occurred in Perambra in Kerala’s Kozhikode in 2018, Dr Shameem Muhammed, a doctor from Kasaragod, asked one of the state's political leaders what would happen if such an outbreak happened in his district.

Dr Shameem’s worst nightmare has now come true. Not Nipah, but Kasaragod has become the district with the highest number of coronavirus confirmed cases in the state.

Since 2015, a group of youngsters under the banner Kasaragodinoridam (A Space for Kasaragod) has been campaigning for the development of the district. They have been fighting a long battle against the negligence shown to the district over the years by successive governments.

It was as part of this movement that Dr Shameem, who is also a representative of Kasaragodinoridam, prepared a report on the poor healthcare facilities in the district. Report in hand, the group approached all kinds of authorities, from the lower level to the ministry for years. But nothing happened.

Now with more than 85 COVID-19 cases the district has become the epicentre for the pandemic. Forty of the patients are under treatment at the Kasaragod General Hospital (GH), which has always been alleged to have poor facilities. Women patients are admitted to the Kanjangad District Hospital as it is much better compared to the GH. Many others are under quarantine in Pariyaram Medical College Hospital in Kannur district as there is no facility in Kasaragod. A majority of the people from the district depend on hospitals and medical colleges in Mangaluru for healthcare and are now facing a lot of difficulty as Karnataka has closed its borders.

Dr Shameem Muhammed

Will this pandemic be an eye-opener for the government about the state of Kasaragod’s healthcare? Dr Shameem spoke to TNM and explained why the healthcare system in the district is the worst in the state.

“Of the three levels of healthcare systems – primary, secondary and tertiary – Kasaragod has just reached the primary level. We have just the basic facilities. No round-the-clock medical assistance and emergency care. We are lacking in number of beds, medical equipment and specialists. That is why people largely depend on Mangaluru, Kannur and Kozhikode for medical services,” Dr Shameem, who is currently a Neurology resident at the Thiruvananthapuram Medical College Hospital, says.

“The district is going to struggle to accommodate patients if the number of cases increase,” Dr Shameem says.

Apart from the GH, Kasaragod has one district hospital in Kanjangad, five taluk hospitals and five Community Health Centres that provide inpatient facilities. But at all these centres the availability of beds is very low, he says.

The Kasaragod GH, though it is the biggest medical centre in the district, has just 230 beds, the lowest in the state. GHs in cities like Thiruvananthapuram, Pathanamthitta, Alappuzha, Kozhikode, Thalasseri, Manjeri, Ernakulam and others have more than 500 beds.

“Unavailability of medicines in the pharmacy, shortage of equipment in the ICU like BiPAP, ventilators and CPAP machines is another problem,” Dr Shameem says.

“There are not many doctors from Kasaragod, those who come from out of town don’t stay there. Specialists are almost nil in our hospitals. An ophthalmologist who studied in JIPMER had joined the GH, he was ready to stay there for a while, but they were not even able to provide him with a lens. So he left,” Shameem recalls.

“Lack of radio imaging facilities, limited availability of Computed Tomography (CT) scanning, unavailability of ultrasonography, doppler and Magnetic Resonance Imaging (MRI). Above everything, super speciality services are very poor,” he adds.

He also says that if COVID-19 patients increase, the district will lack even ventilators.

“To understand the laxity shown to the district, the GH has only one post for radiologist or radio therapist. Both are totally different. Radiologist is a doctor who does radio diagnosis and a radiotherapist is a doctor who treats cancer with radio therapy. We don’t understand why both are given just one post,” he says.

Trauma care, oncology, neurology, cardiology and other super specialities are just up-and-coming in the district.

Reasons behind lack of development

“The primary reason for the underdevelopment of the district is that there is no demand from the public or the people’s representatives. The people have Gulf money so they opt for private hospitals in Mangaluru as an easy option. They don’t know and they haven’t seen the best government hospitals. Apart from that, our political representatives are not demanding development. We have had even ministers from Kasaragod constituency, but it is doubtful whether our leaders took an interest in the development of the district’s health sector,” Dr Shameem says, adding that the public should know what portion of the political representative’s funds are spent on the health sector.

He points out that irresponsibility and corruption in the bureaucracy and Health department are also a reason for the district’s fate.

“Lack of human resources is a major reason. Good doctors and officers don’t stay here,” he points out.

Solutions

When coronavirus cases were reported from Kasaragod there was a call to speed up the establishment of the Kasaragod Medical College, whose construction is almost over. A medical college in Kasaragod has been a long-time dream of the people. Its foundation stone was laid in 2013 but it hasn’t started functioning till now.

Wayanad and Kasaragod are the only districts in Kerala without a medical college. However, a medical school cannot be an immediate solution to the district’s inefficient healthcare system.

“A medical college is obviously a necessity for the district. But it cannot serve immediate needs, it will take at least 15 years after courses commence to serve its purpose. What we should right now is to enhance the existing government hospitals in the district. They have to be developed as super speciality centres,” Dr Shameem says.

“After this coronavirus season, we should form an expert committee that includes specialists, not just the District Medical Officer, real specialists in each stream, political leaders and bureaucrats who can study the shortcomings and lobby for the development of our health sector,” he adds.

According to him, improving the manpower, equipment and facilities in the existing hospitals is the immediate solution.

“Compared to other districts, public contribution to the healthcare development in Kasaragod is zero. But the district has the ability for good contributions. So there should be an initiative to stimulate such contributions,” he suggests.

He also says authorities should not forget about the district after the coronavirus pandemic.