Medical treatment miles away in Kodagu district

Fifty-six-year-old Jyothi Shankar had gone to Cherangala village in Kodagu on some work. He soon developed chest pain and was taken to the government hospital in Bhagamandala, 7 km away. There ECG was done and he was shifted to a hospital in Madikeri, 36 km away.

The ECG report was sent to Dr Padmanabh Kamath, professor and HoD Cardiology Department, KMC Hospital in Mangaluru. Shankar was diagnosed to have had a massive heart attack. The doctors in Madikeri stabilised him and he was shifted to Mangaluru, 150 km away, where he had to immediately undergo angioplasty.

In case of any medical emergency, people in Kodagu need to go to hospitals either in Mysuru or Mangaluru as there is no super specialist or any medical institution that is capable of handling all the complications in case of an emergency in the entire district. ICU beds too are few in numbers.

The population of the district is around six lakhs, whereas the number of tourists visiting this hill station, from across the country as well as abroad, is multiple times this number – it was 17 lakhs in 2018 and 18 lakhs in 2019. While tourism is promoted, the district isn’t prepared to meet medical emergencies of the tourists too.

Even the ECG machine set up by Cardiology At Doorstep (CAD) initiative and the ambulance service – basic healthcare facilities – are relatively new at the government hospital in Bhagamandala.

“The first one hour after a heart attack is called the Golden Hour. Ideally a patient ought to reach a medical centre within this golden hour for restoration of cardiac blood flow to heart. This will in turn translate to early recovery and preservation of heart muscle function,” says Dr Kamath.

However, Dr Kamath rues that on an average there is a delay of 16 to 17 hours in patients reaching hospitals following a heart attack. “Lack of awareness, delay in diagnosis, unavailability of technology and machines, dearth of skilled doctors, lack of ambulance facilities, poor infrastructure and telemedicine facilities are the hurdles to timely medical intervention,” Dr Kamath says.

According to Dr Kamath, in many cases a heart attack is wrongly assumed to be a gastric problem but a simple ECG test can diagnose a heart attack and help save lives.

Why does the district renowned for its scenery, coffee and spices, lag in terms of medical facilities?

There are two main reasons, doctors feel.

“One, as the district is sparsely populated, it is neither economically viable nor practical to have a super speciality hospital. Two, few doctors prefer to work in rural settings, as there is no professional or academic growth here,” says Dr Amrit Nanaiah, Managing Director, Lopamudra Medical Centre, Gonicoppa.

Low population density translates to few patients, as a result there is lower returns on investment. This discourages private bodies from investing in medical centres in the district.
On the other hand, the government hospitals are less equipped to meet the needs of all the patients.

“The current focus should be on streamlining the primary care, increasing the number of paramedics and improving the ambulance service,” says Dr Amrit Nanaiah.

Parallelly, people need to be made aware of the importance of early diagnosis and medical intervention, along with the facilities and schemes they can avail.

The effectiveness of training medical staff in technology and telemedicine was highlighted in Jyothi Shankar’s case. His ECG test was done by Dr Shalini Ponnamma, an ayurvedic doctor and he was stabilised by Dr (Maj) Kushvanth Kolibailu, a paediatrician in coordination with Dr Kamath who was in Mangaluru.

However, there are some improvements in the medical facilities in the recent years. The district’s first medical college – Kodagu Institute of Medical Sciences, Madikeri – was established in 2016.

“There is also a proposal to upgrade the college and introduce post-graduation as well,” says Dr Chethan M U, Surgeon at Government Hospital, Kushalnagar.

Doctors also feel that it is high time, that efforts be taken up at community level too. People of the district need to come together, pool in money and create a fund to cater to the healthcare facilities.

“There are renowned super specialists from Kodagu. Though it may not be prudent for them to practice in the district, a model can be created to offer their services on rotating basis,” says Dr Amrit Nanaiah.