Sh Jai Ram Thakur ji,
Govt of HP
Sub: Complaint regarding pathetic medical facilities in Lahoul-Spiti district which amounts to denial of Right to Life enshrined in Article 21 of the Constitution, as interpreted by Hon’ble Supreme Court in its various rulings and also amounts to discrimination against the ST population of the district
Warm greetings from Lahaul & Spiti!
We write this to humbly submit that, as you are aware, the remote tribal district of Lahaul- Spiti which shares its border with Tibet, is spread over small villages in three sub divisions of Keylong and Udaipur in Lahaul valley and Kaza in Spiti valley and happens to be the largest district of the state having geographical area of 13835 sq kms and constitutes 24.85% of total area of the state.
The rugged mountainous terrain, extremely harsh climatic conditions accompanied by heavy snowfall during winter months- all combine to severely impact the living as well as the health conditions of the people of the district.
Chronic deseases and other common ailments
Although no systematic studies have so far been carried out, available information suggests that chronic diseases such as hypertension, diabetes, cancer, heart disease, and arthritis are on the increase. Nearly 70 per cent of all deaths in the district are caused by chronic or so-called lifestyle diseases which appear now to occur at a relatively younger age. Acute respiratory diseases and reproductive-tract infections especially women are also common in the district. According to NFHS-4, nutritional anaemia among children and women in the district of 94% and 85% is a matter of serious concern.
An outbreak of hepatitis B virus has recently been reported in Spiti valley where nearly 16 per cent people tested positive for hepatitis B which is 8-times higher than the national average of 2-3%.
Health services in the district provided through a network of 36 sub centres; 16 primary health centres (PHCc); 3 community health centres ( at Shansha, Udaipur and Kaza), and a Regional Hospital at Keylong are perennially plagued with staff shortages as testified by the following data on vacant posts which vary from 28% among staff nurses to 100% in case of specialists and lab technicians.
Hospital beds: Total sanctioned: 150; Available: 66 (44%)
Staff situation (as on 1st August 2018)
(staff situation as on 31.12.2018 was, more or less, the same)
1) Total posts (medical and paramedical): 445, Vacant: 225 (53%)
Medical officers: Sanctioned: 49; Vacant 22 (45%)
Specialist posts: sanctioned: 7; Vacant: 7 (100%)
Dental surgeon posts: Sanctioned: 8; Vacant: 7 (87%)
Staff Nurse: Sanctioned: 39; Vacant: 11 (28%)
Laboratory Technician: Sanctioned: 16; Vacant: 16(100%)
2) At PHC level, of the 22 posts of medical officers, 7 posts(32%) are vacant. Four PHCs ( at Sissu, Hinsa, Kibber, and Rangrik) are functioning without Medical officer, 11 PHCs are without staff nurse and 15 PHCs are without lab technician. None of the PHCs has a health educator or a program manager. In the absence of health educator or program manager in the PHCs, the lone doctor in each of the PHCs has to spend much of his/her time in carrying out administrative work which leaves very little time for attending to patients.
3) There are 37 sub centres and out of 37 posts of male health workers, 25 posts(68%) are lying vacant.
4) At the Regional Hospital at Keylong,15 (71%) of the 21 posts of medical officers are lying vacant including all the 7 posts of specialists. Thus there is not a single surgeon, anaesthetist, obs/gynecologist,paediatrician, public health specialist, or a general medicine specialist in the Regional Hospital and, indeed, in the entire district. These 7 posts of specialists have been lying vacant for the past many years.
5) The district does not have a single private hospital or a physician with the result that people have to depend entirely on the government health facilities which, as is evident from the above facts, are far from being adequate even to provide basic health services to the people given the fact that large number of posts of medical and paramedical staff are lying vacant and there is not a single specialist in the entire district and diagnostic facilities available are highly inadequate.
Infrastructure at Regional Hospital, Keylong
1) There is no intensive care unit in the Regional Hospital
2) Internet connectivity in the hospital premises is intermittent, having to depend largely on VSAT. This severely impacts the overall functioning of the Regional Hospital.
3) The operation theatre is in a non-operational state, without blood bank and without an anaesthetist and a surgeon. Also, there is no radiotherapy service available in the Regional Hospital.
4) The labour room is not of much use in the absence of services of a gynecologist. The post of gynecologist has been lying vacant for a long time.
5) Tele-medicine service is available in collaboration with Apollo Hospital, Chennai which is connected via VSAT. Due to geographical distance between the Lahaul-Spiti and Chennai, follow up visits by patients to Apollo Hospital, Chennai is almost impossible with the result that this service is not of much practical use. The Regional Hospital is not linked with IGMC Shimla, Dr Rajendra Prasad Govt Medical College Kangra at Tanda or with PGIMER Chandigarh, all of which are closer to the district as compared to Chennai and, therefore, much more convenient from the point of view of patients’ follow up visits.
X-ray machines available at Keylong and Udaipur are totally outdated (1997 vintage). Same is the case with ultrasound machines. There is no facility for CT Scan, no treadmill and no TMT facility. Equipments required for retinoscopy, audiometry, bronchoscopy and opthalmoscope are not available. Ventilator is in a damaged condition and the same is kept in the store.
Only routine test facilities are available in the Regional Hospital. There is no facility for culture sensitivity and ELISA test.
Pregnancy and child birth
Absence of gynecologist in the Regional Hospital and, indeed, in the entire district leaves the pregnant women with no option but to move to hospitals in Kullu involving several hours of back-breaking journey, for antenatal follow up and child delivery. Same is not possible during winter months when the Rohtang pass remains snowbound, except through occasional and irregular helicopter service which is often not available when a pregnant woman needs it the most.
Difficulties caused by the woefully inadequate medical facilities in the district
Even though, as mentioned earlier, Lahaul -Spiti is the largest district of Himachal Pradesh in terms of area and one of the bigger districts in the whole country, the medical facilities available in the district are abysmal and woefully inadequate.
During winter months, due to heavy snow on the Rohtang pass (13050 ft above sea level), critically ill patients of Lahoul valley have to be airlifted outside the district for proper investigation and treatment. Apart from the prohibitive cost involved in arranging airlift which majority of the people living in the district can ill afford, helicopter service is not easily available when needed the most and, in emergency situations, any delay in airlifting the patient can have fatal consequences. Even though patients in critical condition who need urgent medical attention can also be transported outside the district through Rohtang tunnel but the same is possible only if the Border Roads Organisation officials allow the patients to be transported through tunnel in view of the fact that tunnel is still not complete and the same is yet to be thrown open to vehicular traffic. It would be pertinent to mention here in this connection that, due to poor medical facilities available in the district, during the last winter, as many as 158 patients were referred from Lahaul valley to hospitals in Kullu and 10 patients were referred from Spiti valley to hospitals outside the valley.
Even during summer months, in the absence of adequate medical facilities in the district, critically ill patients have to be transported through Rohtang pass only at grave risk to their life given the fact that it involves painstaking journey for several hours.
Denial of adequate medical facilities in the district amounts to denial of Right to Life as interpreted by the Hon’ble Supreme Court in its various rulings
1) In Devika Biswas vs UOI & ors, it was held by the Hon’ble Supreme Court that it is well established that Right to Life under Article 21 of the Constitution includes right to lead a dignified and meaningful life and right to health is an integral facet of this right.
2) In Consumer Education and Research Centre vs UOI (21), the Hon’ble Supreme Court held that right to health was an integral part of a meaningful right to life and that right to health and medical care is a Fundamental Right under Article 21.
3) In Paschim Banga Khet Mazdoor Samity vs State of West Bengal & ors (23), it was held by the Hon’ble Supreme Court that under Welfare State Policy, primary duty of the govt is to provide adequate medical facilities for its people.
Since, at present, even basic medical facilities are not available in the district with a large number of posts of medical staff including specialists and paramedical staff lying vacant nor are there adequate diagnostic facilities available, the same constitutes clear and flagrant violation of the abovementioned rulings of the Hon’ble Supreme Court.
Discrimination against the Scheduled Tribes population of the district
Since Lahaul-Spiti is a tribal district, the utterly pathetic condition of the medical facilities and lack of diagnostic facilities in the district also amounts to discrimination against the ST population of the district.
In view of the above facts, it is most humbly requested that the govt may kindly ensure that proper medical and health care facilities are made available in the district on priority basis by filling up vacancies of medical and paramedical staff including specialists and by providing requisite diagnostic facilities. This is particularly necessary in view of the remoteness of the district which makes it extremely difficult for the critically ill patients living in the district to reach hospitals outside the district in time for getting specialised medical service.
Need for providing incentives to doctors and paramedical staff serving in Lahaul-Spiti district
In view of remoteness of the district and its geographical isolation and difficult working and living conditions including inclement weather and hostile climatic conditions accompanied by heavy snowfall during winter month, the govt is requested to provide suitable financial incentives to the medical and paramedical staff serving in the district. They must also be provided with suitable housing facilities. It should also be ensured that, as soon as the fixed period of posting (two winters and one summer) is over, they must be posted out of the district without any delay by asking them to indicate three choices and posting them to one of the three places indicated by them and by exempting them from having to approach politicians for recommending their transfer in writing as is the existing practice as the same causes inordinate delays. If it is not possible to post them to one of the three places indicated by them, reasons for the same should be recorded on file by the competent authority and communicated to the concerned medical/paramedical staff. However, in case of those who are willing to serve in the district beyond fixed period, same should be allowed.
Incentives provided to the medical doctors and paramedical staff by various states for working in rural/remote areas
It would be pertinent to mention here that as many as 18 states are providing various incentives for the doctors and paramedical staff for serving in rural and remote areas. To cite a few instances, in Odisha, doctors are paid upto Rs 80000 in addition to their salary for serving in the remotest parts of the state. Doctors posted in the remote, tribal and Naxalite violence affected areas in Chhatisgarh are paid upto Rs 70000 in addition to salary and, in addition, they are also paid Rs 30000 as performance related bonus. Specialists are paid a salary of about Rs 2 lakhs for serving in such areas of the state. In Maharashtra, doctors serving in difficult areas are paid extra pay grade and NPA as 50% of basic pay . Specialists serving in rural areas of the state are paid 3 increments(in case of diploma holders) and 6 increments(in case of PG degree holders). Under NHM, Govt of India provides incentives such as hard area allowance for doctors serving in rural and remote areas as well as residential quarters for doctors so that they find it attractive to serve in such areas. Haryana, Maharashtra, Nagaland, Rajasthan and Tripura and Tamil Nadu provide additional monetary incentives not only to doctors but also to ANMs, nurses and paramedics while many of the states provide additional monetary incentives to doctors only.
We, therefore, humbly submit even at the cost of repetition that the situation with regard to medical and healthcare facilities in the district cannot and will not improve unless suitable financial incentives as well as comfortable housing facilities are provided to the health staff posted in the district and fixity of tenure is assured. As suggested above, the medical and paramedical staff should remain assured of their transfer outside the district soon after completion of their tenure, without having to approach politicians to recommend their transfer in writing as is the existing practice. Unless such policies are adopted and put in practice, they will continue to feel reluctant to serve in the district for reasons stated in foregoing paras and the district will continue to have large number of vacancies of medical and paramedical staff as is the case at present.
Col (retd) Prem Chand, KC, SM, VSM of village Lindoor, Lahoul
Sh Tashi Dawa of village Shansha, Lahoul
(retd IPS officer andformer DGP,HP)
Sh SS Kapur of village Tholang, Lahoul
(retd IAS officer and formerChief Secretary, J&K)
Sh BS Parsheera of village Rangbey, Lahoul
(retd IAS officer and formerSecretary to GOI)
Dr BS Rawal of village Shansha, Lahoul
(former Project Director AIDS Control, HP)
Dr Jai Prakash Narain of village Shansha, Lahoul
(former Regional Adviser & Director,World Health Organisation, Regional Officefor South-East Asia)
Sh Subhash Kumar of village Kuiling, Spiti
(retd IAS officer and former Chief Secretary, Uttarakhand)
Smt Sarojini Thakur of village Khangsar (Tod), Lahaul
(retd IAS Officer andformer Addl Secretary, Himachal and Chairperson, HP Private Educational Institutions Regulatory Commission)
Sh Ashok Thakur of village Khangsar (Tod), Lahaul
(retd IAS Officer andformer Secretary (Education) to Govt of India
Col (retd) Tashi Dogra of village Lote, Lahoul
Sh Prem Singh of village Rangbey, Lahoul
(retd IPS officer and former DGP, Meghalaya)
Sh Pritam Thakur of village Jahlma, Lahoul
(retd IPS officer and former DGP, Gujarat)
Sh Prem Singh Sharma of village Tholang,Lahoul
(retd IRAS officer and former FinancialAdvisor and CAO, Western Railways)
Sh PS Rawal of village Shansha, Lahoul
(former Addl DG, RPF)
Sh Sundar Thakur of village Khangsar,Lahoul
(former Principal Commissioner,Customs and Central Excise)
Sh Ranjit Thakur of village Sumnam,Lahoul
(retd IOFS and former GeneralManager Ordnance Factory)
Sh BD Parsheera of village Rangbey, Lahoul
( retd Principal of Sr Sec School)
Dr Bir Singh Sahni of village Lote, Lahoul (retd CMO)
Dr PD Lal of village Tholang, Lahoul
Sh Roop Singh of village Rawaling, Lahoul
(retd DIG, SSB)
Dr Shamsher Pujara of village Ghushal,Lahoul
( retd CMO)
Dr Mohan Lal of village Ghushal, Lahoul
Sh Ram Nath of village Shooling, Lahoul
(former Chief General Manager & Country Head, SIDBI)
Sh GC Gailong of village Beeling, Lahoul
(retd GMand Director, GIC)
Sh Prem Katoch of village Sissu, Lahoul (DySP retd)
Sh Prem Singh Thamas of Upper Keylong, Lahoul
(retd AGM, SBI)
Sh Tashi Chharing of village Raling, Lahoul
(retd Chief Manager, Indian Overseas Bank)
Sh RN Vidyarthi of Lahoul
(retd Registrar Vigilance, Forest Deptt)
VICE CHAIRPERSON OF ZILA PARISHAD AND
GRAM PANCHAYAT PRADHANS OF LAHOUL-SPITI
Smt Shashi Kiran of village Ghushal, Vice Chairperson
of Zila Parishad, Lahoul-Spiti
Sh Sat Prakash, Pradhan, Gram Panchayat, Warpa, Lahoul
Sh Rajesh Rappa, Pradhan, Gram Panchayat, Jobrang, Lahoul
Sh Surender Kiru, Pradhan, Gram Panchayat, Jahlma, Lahoul
Sh Arvind Katoch, Pradhan, Gram Panchayat, Gohrma, Lahoul
Sh Saroj Kumar, Pradhan, Gram Panchayat, Nalda, Lahoul
Sh Sher Singh, Pradhan, Gram Panchayat, Langcha, Spiti
Sh Tapka Angchuk, Pradhan, Gram Panchayat, Losar, Spiti
Smt Dechen Butith, Pradhan, Gram Panchayat, Hull, Spiti
Sh Sanjeev, Pradhan, Gram Panchayat, Khurik, Spiti
Smt Tenzin Angmo, Pradhan, Gram Panchayat, Kibber, Spiti
Sh Chewang, Pradhan, Gram Panchayat, Sagnam, Spiti
Smt Lamo Butith, Pradhan, Gram Panchayat, Kaza, Spiti
Ms Tanzin Angmo, Pradhan, Gram Panchayat, Demul, Spiti
Ms Dechen Angmo, Pradhan, Gram Panchayat, Tabo, Spiti
Dr Jai Prakash Narain
Senior Visiting Fellow, University of New South Wales, Sydney, Au
Mob: 0091 8800876855, 9582811148
Former Regional Adviser & Director, Communicable Diseases
WHO Regional Office for South-East Asia