In an exclusive interview with Dr. Qazi Haroon, a public health expert in Jammu and Kashmir, we dive into the current state of healthcare in the region. With over 15 years of experience, Dr. Qazi offers invaluable insights into the challenges, successes, and ongoing efforts to improve health outcomes in Jammu and Kashmir.
KO: How do you overview the public health scenario in Jammu and Kashmir?
Dr. Qazi: The core of public health is divided into three key areas: Preventive, Promotive, and Curative healthcare. We always strive to prevent illness before it occurs. Prevention is the pillar on which public health stands. There are various aspects to prevention, such as educating people about the factors that can cause illness. As we all know, prevention is better than cure. So, in public health, we always focus on disease prevention from the very start. Now, if, God forbid, a disease occurs, we then assess its ramifications, the economic burden it places on the society, and how the community will be impacted. This remains a primary concern for public health experts.
For example, when COVID-19 hit, it impacted the entire world. At that point, the curative aspect took precedence. However, those who were not affected by the virus benefited from the preventive measures in place.
There are various programs under the Ministry of Health and Welfare that target different diseases. For instance, if we talk about immunization, the world now understands its importance. Before immunization was widespread, many children died due to a lack of vaccines. Once vaccines were introduced, the death rate among children significantly decreased.
I personally had the privilege of being involved in the 2018 Measles Rubella Campaign. Initially, we thought it would be an easy task, but once we got into the field, we realized how different program management is compared to sitting in an office. Despite the challenges, we vaccinated 38 lakh children in just 6 weeks, making it one of the best performances in the country. We were even awarded for our efforts. My point here is that these are some of the preventive measures the UT (Union Territory) or State should implement to avoid future cases of measles. Today, the number of measles incidents has reduced drastically.
Further on immunization, there have been campaigns like Mission Indradhanush, which targets children who have missed vaccines. By focusing on these left-out or dropout children, we’ve been able to achieve 100% immunization coverage in Jammu and Kashmir, making it one of the best UTs in India in terms of immunization rates. This is a significant achievement.
KO: You are currently posted in a remote area. You’ve worked on immunization and family planning. When you go into the field, you see a lot of disconnect. Do you think there is something like that?
Dr. Qazi:Working at the state level, district level, division level, and block level is very different. But I’ve seen that the health department in Jammu and Kashmir is doing exceptionally well because of the doctors, paramedics, and other people who are implementing these policies and programs on the ground. I wouldn’t say there is a disconnect, but I would say that certain areas need improvement in terms of training, remuneration, and overall program management.
Jammu and Kashmir has some of the best health indicators in the country. I’ve traveled a lot in my 15 years and visited many states like Odisha and Rajasthan. I can tell you that our primary and secondary healthcare system is one of the best in the country. Yes, there are some challenges with human resources (HR) in certain places, but the infrastructure and facilities are well-established. However, we need to understand that doctors and healthcare workers do not have a magic wand. In Western countries, people are more aware of what is needed in a hospital. There needs to be greater awareness in our communities about what is expected in hospitals and health centers. I’m not saying that our patients expect luxuries, but they should understand that healthcare providers also have basic human needs.
In 2009-2010, I was posted in a hospital in Srinagar, and after a very hectic night shift, I finally got a chance to eat. As I started having my meal, a patient came knocking at my door, and when they saw me eating, they were surprised. The patient then told me they had been experiencing itching in their hand. While the concern was genuine, I was surprised by the urgency, as it was not an emergency. This is why we often witness doctor-patient conflicts. People need to realize that healthcare providers are working 24/7, they too have families, and they also get tired.
KO: You were also the program manager for NHM (National Health Mission). Given your extensive experience, why do we see a high rate of cesarean sections, especially in private hospitals? Why are these cesareans unchecked?
Dr. Qazi: I was the state program manager for NHM, particularly focusing on maternal health, for at least three years. During this time, we worked hard to reduce the cesarean section rates. In my opinion, there are multiple reasons behind the high rate of cesarean sections. It’s not just about the decision of the mother; the whole family is often involved in the decision-making process. In the past, women were more inclined to go for normal delivery, but today, many view cesarean as a quicker, less painful option.
Even though we’ve tried very hard over the past 3-4 years to reduce the cesarean section rates, we still have one of the highest rates in the country—over 60%, compared to the WHO recommended range of 20-25%. However, there has been some decline, with Pulwama district showing the highest rate.
KO: How harmful is a cesarean section, and how beneficial is normal delivery?
Dr. Qazi: Normal delivery is always preferable. It allows for a smoother recovery and a healthier outcome for the mother and child. A cesarean section, on the other hand, leaves a permanent scar, and future deliveries are likely to require cesarean sections. There are also risks associated with cesarean sections, such as infections and other complications. Over the past 5-6 years, we have implemented a communication strategy during the first ANC (Antenatal Checkup), where we educate patients about the benefits of normal delivery and the risks of cesarean sections. It’s important not only for the health department but also for the family to understand the merits and demerits of each option.
KO: There have been reports of corruption and malpractice in private hospitals regarding cesarean sections. Do you think there should be stricter checks by the government?
Dr. Qazi: It’s not that the government is not checking private institutions. In fact, we’ve implemented a cesarean section audit system, which is done daily, weekly, and monthly. All hospitals are required to submit cesarean section formats with justifications for why they performed the surgery. This audit system is part of the Ministry of Health and Welfare’s directives to ensure that every cesarean performed is medically necessary. I was also part of this program where we audited every cesarean conducted, whether in centralized hospitals or peripheral ones.
KO: Do you think there’s a need to revive the concept of midwives? And what is the role of ASHA workers?
Dr. Qazi: During my time with NHM, I was involved in the Midwife Initiative, where we aimed to train nurses as midwives to facilitate normal deliveries. Many Western countries still use midwives as an integral part of their healthcare systems. We need to focus on ensuring that women go into delivery with the mindset that normal delivery is the best option. In Kashmir, the rise in cesarean sections is concerning, and this mindset shift is essential.
ASHA workers play a crucial role in supporting normal deliveries at the grassroots level. We need to empower and train them to promote normal deliveries and assist women effectively.
KO: Drug addiction has reached alarming levels in Kashmir. Recently, we received data showing a large number of distress calls from families of drug addicts. Through the Genesis program, what can you say about the magnitude of this issue?
Dr. Qazi: I was part of the Tele MANAS program from the start, and it has proven to be a lifeline for people in Jammu and Kashmir. We didn’t initially realize that it was just the tip of the iceberg. We have many people struggling with anxiety and depression, and through Tele MANAS, we were able to connect with them. Tele MANAS is a helpline where people can reach out anonymously, and the program uses a three-tier system of counselors, clinical psychologists, and psychiatrists to provide support.
There’s still a stigma around mental health in Jammu and Kashmir. People are hesitant to seek help due to the fear of being labeled as ‘insane.’ Through Tele MANAS, we’ve received a massive response, and many young people—aged 13 to 18—have reached out with issues like career concerns, family problems, and academic stress. Last year, we received over 70,000 calls.
KO: Do you think raising awareness about mental health will be a game-changer?
Dr. Qazi: Absolutely! If more people avail themselves of mental health services, many cases can be reversed. They don’t always need to visit a doctor. By educating people and offering anonymous support, we can address mental health issues more effectively and reduce the stigma surrounding them.
- Transcribed from video format to text by Nida Sadiq
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