Vice-President of Indian Doctors Forum (IDF) and an Anesthesiologist,
Dr Abhay Patwari, Farwaniya Hospital, Kuwait, shares his experience and knowledge of specialisation that is often overlooked by patients in Critical Care
How are modern hospitals providing Critical Care to patients?
A proper well-planned and designed CCU with adequate well-trained staff and equipment has to be established and commissioned. The establishment of a CCU is very capital intensive and requires large amount of fund. A CCU is not a primary admitting department but one that provides service. Some CCUs have an open-door policy where in the primary physician/surgeon continues to follow his patient in the ICU. Some CCUs have a closed door policy where in the CCU takes over complete management of the case until the patient is ready for discharge.
What are the latest devices and technologies available for the CCUs?
With advances in microprocessor technology, a plethora of equipment is now available to perform life-supporting function as well as monitoring of vital parameters and there is no end in sight as far as innovation is concerned. Every year more sophisticated and expensive equipment is introduced.
Government should introduce licensing and inspection by a committee to assure that all life saving equipment and medication is available and functioning in the hospital. It should take cognizance of any irregularity or malpractice if reported
How community and district hospitals can take advantage of Critical Care?
To establish a CCU at every community and district hospital is an impossible proposition. They must have basic resuscitation capabilities and tie-ups with a regional tertiary referral hospital and efficient transport system. They could stabilise the patient at their end and then transfer them to a step-up CCU at a larger hospital or a tertiary care hospital. They could be equipped with some simple ventilators and monitors to tide over the crisis.
What are the challenges faced by the hospitals in delivering Critical Care in India. What is the present and future of critical care in India?
The number of Critical Care beds is not sufficient to cater to the demand. It is possible that some lives are lost for non-availability of care. The lack of trained manpower is another constraint. Lack of funds for establishment and then maintenance of CCU is a severe impediment. CCU care is very expensive and patients cannot afford it unless there is universal medical insurance. With liberalisation of economic policy and recognition of hospitals as industry and the entry of corporate in medical care “ the quality and availability of CCU services is vastly improved. However, the rural areas suffer badly due to lack of facilities and bad connectivity.
What are the Critical Care facilities you have in your hospital?
In Kuwait, the CCUs are under the Department of Anesthesia. We have 35 beds in the CCU which is the largest in the country. Both the ICUs are well equipped and staffed. On an average, we have about 50 admissions per month and the mortality rate is about 15-20 percent which is at par with international standards. ICU care is free and therefore sometimes misused for prolonging life in terminal cases. An organ harvest and transplant programme is active and cadaver donors are used.
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