SCI stretched too thin

SCI (State Cancer Institute), SKIMS has become a reference point and a refuge for the patients afflicted with life-threatening illnesses. With a couple or so of modest teams of senior consultants and a host of junior doctors and resident trainees, it has gained deserved recognition for handling, dissecting, and managing complex diseases with care and competence. Patients are monitored on a date-wise basis, and even those without appointments are attended to during late hours. An act of compassion worth commending.

Doctors here discuss each case with microscopic precision, as if operating on an ant, poring over every detail, from the earliest symptoms to the most recent diagnoses. They track the stage and progression of the disease, including its type and subtype, and prescribe chemotherapy/immunotherapy/radiotherapy doses to relieve the patients of persistent pain. The thoroughness and consistency are exceptional.

The nursing staff, too, is remarkably diligent. Meticulously managing patient doses, they reduce patient agony substantially. Even the faintest gesture is enough for them to assist the patients promptly. Without hesitation or a raised eyebrow or a face-palm or any hint of indifference.

But. That said. All is not well!

A shadow cuts through the light of SCI, making one feel the most desolate at times. When I say desolate, I mean gnawing helplessness, frustration, and distress - by no fault of the caregivers, but by systematic failure and structural neglect.

The curse of a single PET scanner:

With 50000 new cases reported in the last seven years, it is distressing that our SKIMS SOURA operates with only one PET scanner (for staging and mapping the spread of the disease). For patients silently battling pain on the inside, it takes more than three weeks to a month for the scan. But cancer, especially metastatic, doesn’t wait. It can take even weeks, if not days.

A PET scan costs over twenty-five thousand rupees at a private hospital in the valley and more than ten thousand rupees at SKIMS. Many patients, travelling from the hilly and rugged areas and living hand to mouth, can barely afford this money. And after arranging the funds, they are supposed to wait weeks for the PET assessment.

This aside, the tragic part of it is the spread of the disease before the scheduled date for PET-CT comes—the patient remaining without diagnoses, medicine, and thus pain relief.

Overburdened Senior Consultants:

Senior doctors are like dew on a rising tide of patients. Try visiting OPD, SCI, SOURA, and you will see weary faces, long lines, and patients jostling for spaces and struggling to get in to meet the doctor. You will witness patients and attendants almost on top of each other in the cramped hallway shared uncomfortably by the hematology, radiology, and medical oncology wings.

However hardworking and receptive these doctors may be – working from the morning straight into the twilight hours – folks suffer, not from the doctors’ lack of skill and compassion, but from endless waiting, insecurities, anxieties, and a crushing load that outpaces capacity.

Doctors aren’t to blame. They themselves are helpless, too constrained by the system. The real rot lies in not expanding the pool of senior consultants. There should be at least five to ten additional senior oncologists available to handle the swelling numbers.

Appointments that stretch across months:

This is the most frustrating issue of all. If you wish to meet the doctor for a follow-up appointment or a new concern, be ready to wait for months. Not a day earlier given. Thanks to some doctors seeing to their patients sans appointment late into the evening.

But how long can a few cover for a systematic flaw? This is a foundational fault line, one that shakes the very core of organized medical treatment and professionalism.

Again, the doctors aren’t at fault, but the jinx of not confirming the rush of patients in person by those whom it may concern is: administrators bear the responsibility. They cannot steer a crumbling cart while claiming all is well. We need a meaningful infrastructural expansion and human resources to keep up with the rising demand.

Challenges in Short-Stay Admissions:

Despite the nursing staff’s commitment, patients often struggle to get short-stay admission in time. Patients and attendants have to wait and roam for an hour or two for an opening. Beds are limited. And the growing stack of pending admission slips in the queue on a daily basis is disheartening. Meanwhile, green spaces lie idle within the hospital premises - unused, dead, and wasted. A symbol of potential never realized. Infrastructure expansion remains half-hearted and certainly insufficient.

No radical change. Just resignation.

Ayushman Bharat - The Endless Loop:

For patients seeking medicines under Ayushman Bharat, the ordeal is exhausting. Attendants – already reeling under mental and physical strain - are made to traverse a long, bureaucratic maze:

The process involves getting admitted (taking more than two hours); receiving the drug requisition by doctors (taking an hour approximately); stamping the monetary package at a couple of places (taking another hour); waiting in a long queue to get the medicine at MRD (taking another half an hour or so); and visiting a medical store empanelled half a kilometer away from the hospital premises (taking yet another hour or more).

One wonders at the complexity of it: a welfare scheme or an endurance test? For the weary and the weak, it is not just injustice but downright cruelty.

Administrative and Behavioural Gaps:

The way security guards and document custodians at times speak with the attendants upon request is unacceptable. Burnout conditions, a need for control, or an instinct to be protective of sensitive details of patients may explain their actions. But misbehaving with a helpless patient or his overwhelmed attendant(s) lands like blows.

And it again reflects deeper issues: inadequate frontline staff training, zero performance evaluations, and minimal accountability.

There’s no recognition system in place, rewarding the most professional and reinforcing humility through meaningful incentives.

Disclosure: The author of this piece has observed the workings of the SCI for over three years. What he endures, he now places before you. Not to shame or blame, but to urge reflection and action. He hopes that this account isn’t ditched, dismissed, and forgotten.

Will the silence remain the loudest response?