Srinagar: In Jammu and Kashmir, a major lifeline meant to save cardiac emergencies, ‘Save Heart Kashmir’ — an initiative using social networking application WhatsApp, has been lying defunct with doctors facing trouble to get exact updates about patients facing heart attacks.
On 20 December, Waseem Ashiq, a graduate in dentistry, from southern Kashmir’s Pulwama district suffered a heart attack in Srinagar’s Nowgam area.
The 40-year-old, who was married, was taken to a private hospital in Srinagar where from he was shifted to Shri Maharaj Hari Singh (SMHS) Hospital for ventilator support.
“At SMHS, there was no ventilator available when he was brought in. Doctors were planning to shift him to another hospital, but he died before that,” said late Waseem’s friend, Dr Imtiyaz Banday, who works as a medical officer at Sub District Hospital, Beerwah.
He said medically, there were chances of Waseem’s survival but unfortunately there was no life support at the SMHS Hospital which is facing a dearth of intensive care facilities.
“If the WhatsApp initiative had been functional, the doctors at the private hospital would have helped to save him. He was young,” he said.
Heart attacks double in winter months in Kashmir, a Himalayan zone.
As per doctors, managing cardiac emergencies has been an exhausting task as the internet remains blocked since 5 August after the Centre’s move to abrogate Article 370, which provided special status to Jammu and Kashmir and bifurcate the state into two Union Territories.
The Save Heart Kashmir initiative was started by three doctors in 2017. Now, it includes a network of over 1,000 doctors who are saving patients suffering cardiac emergencies especially in the peripheries. It achieved milestone status over the past three years by handling life-threatening cardiac emergencies, but is now defunct due to the internet gag.
The last message on the WhatsApp group posted on 4 August was about an ECG report of a patient. Since communications were suspended, it has become difficult to trace cardiologists who could give advice and suggestions in some complicated cases.
“We would put ECG reports of cardiac cases in the WhatsApp group and we would get instant suggestions from the specialist doctors of tertiary care hospitals and patients were treated in the peripheral hospitals,” said Banday.
Doctors associated with the WhatsApp initiative say that despite the communication gag, they are handling cardiac emergencies. “Earlier, doctors would send reports of patients via WhatsApp and we would analyse and give them feedback instantly. How can they manage it now? They are facing difficult problems due to the internet gag,” said Dr Nisar Ahmad Tramboo, head, Department of Cardiology, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar.
“We are facing many problems in managing or handing cardiac cases. There have been a lot of problems for patients also. All doctors including cardiologists are at the receiving end,” he said.
As per research published by Nations within Nations, heart attacks are among the major killers of adults in Jammu and Kashmir. Kashmir’s two major tertiary care hospitals, SKIMS and SMHS Hospitals on an average receive at least twenty cases of heart attacks in the winter.
As per cardiologists, Save Heart Kashmir is the initiative across the globe that has been successful in saving patients.
Dr Irfan Bhat, a cardiologist at the SMHS Hospital, said that a few days ago, there was a case of heart attack in Bijbehara Hospital, in South Kashmir.
“One doctor called me from there me at 11 pm. He was confused about what to do. I asked him to give life-saving drugs and I suggested he follow further protocol and later the patient survived,” he said.
Bhat said that due to the lack of internet, they can’t prescribe modern medicines. “Every day, every week a doctor has be updated. We can’t keep up when there is no internet.”
“Through the WhatsApp initiative we were catering to remote areas of Poonch, Rajouri, Uri and Tangdar. Without that how can we put our suggestions, we are handicapped. We would read the ECGs of patients and specialist doctors would react instantly in the group,” he said.
Bhat noted that in Kashmir heart attacks increase in the winter, but this year saw a different trend due to the months-long lockdown.
“We saw more heart attacks in the summer due to the prevailing situation. But we don’t know how many patients die on the way to hospitals,” he added.
As per doctors, at the Valley’s peripheries there are no cath labs. The facility is available only at tertiary care hospital in Srinagar which is putting large chunk of patients at risk.
“Doctors at peripheries do thrombolysis, but what happens if thrombolysis fails? The patient has to be taken to a cath lab — which isn’t available — and any delay can put the patient’s life at risk,” said Bhat who is also part of the WhatsApp-driven group.
Dr Nasir Shamas, a consultant physician at Srinagar’s Jawahar Lal Nehru Memorial (JLNM) Hospital and one of the founding members of the Save Heart Kashmir initiative, said they had apprehensions after 5 August that the internet gag would cause deaths.
“Our doctors have managed some of the most dire cardiac emergencies, despite the ongoing internet blockade. It is just because they had been trained under the initiative in the past three years,” he said.
The unique initiative, supervised by super specialists, has nearly completed three years and at least 38,000 cardiac emergencies have been handled in these years. It has proved to be lifeline for hundreds of patients.
As per Shamas, many health care institutions in India have put forward their interest that they would also like to replicate the same since there is zero cost to the exchequer.
“We used to track patients by using WhatsApp and then accordingly we would manage their treatment in hospitals. Now it is being done over phone which is an exhausting task,” he said.
Quoting research, he said since Kashmir is prone to cold, there are 20 to 40 percent chances of an increase in heart attacks in the winters.
Dr Rehana Kousar, epidemiologist at Directorate of Health Services Kashmir (DHSK) said all the doctors across Kashmir hospitals are trained for the initiative, which is voluntary.
“They have been able to handle cardiac emergencies in a difficult time. All doctors are trained and the drugs remain available in hospitals. In these four months, we were able to save lives despite the internet blockage,” she said.
“We have trained hundreds of doctors and given them basic life support skills,” she said.
Kousar, who is also in charge of the initiative, said it is the first time in India that WhatsApp was used for acute emergency care, adding that it aimed at reducing time and empowering doctors to recognise cardiac anomalies and give appropriate treatment.
As per health experts, earlier, heart attack patients would come to peripheral hospitals and doctors were scared of giving life support as they had no training.
Doctors in Kashmir have been demanding restoration of internet service to hospitals but the government is in no mood to restore the facility to health facilities.
Earlier, this month the lieutenant-governor’s advisor, Farooq Khan had said that the internet in Jammu and Kashmir would be restored soon. “The situation is becoming normal very fast. The day won’t be far when you will be using internet. I can’t say the exact date,” Khan had said.
Dr Suhail Naik, president of the Doctors Association Kashmir (DAK), said the continuous internet blockade has made the job of doctors much more difficult.
“The delivery of best medical services largely depends on a continuous learning process through the internet as medical knowledge keeps rapidly evolving with new emerging diagnostic practices and delivery of patient care,” he said.
Similarly, the internet shutdown has affected research activities in medical college in Jammu and Kashmir which is compelling research scholars and postgraduate students from Kashmir to move outside to prepare their research project.
“We don’t have even chosen the topics for our projects. How can we choose the topic? In the absence of the internet, we are unable to get resources,” said a first-year postgraduate student at Government Medical College, Srinagar.
Interestingly, the Medical Council of India (MCI) had made available video lectures and those are mandatory for the students but the students are not able to access the videos leaving them worried. Doctors serving patients narrate similar tales. An anaesthesiologist at SKIMS said in many departments — especially in critical cases, they need to check the case online and are facing difficulties in managing patients.
“Sometimes we need to check online about the treatment related issues of patients. Often, there are difficult cases or unusual cases and those cases are difficult to manage when there is no internet,” he said.