By Dr. K. Javeed Nayeem, MD

Over the last one week we have been reading very distressing reports of how a patient of a heart attack, died most tragically in Canada, simply because prompt medical aid was not available to him within the time frame in which it could have saved his life.

Prashant Sreekumar, a 44-year-old man of Indian origin and a full-fledged, long tax-paying Canadian citizen, reportedly died of cardiac arrest on December 22, while waiting for definitive treatment at a major hospital in Edmonton, Canada.

An accountant by profession, Sreekumar’s family rushed him to the hospital after he experienced severe chest pain and blurred vision in one eye while at work. At the hospital, he was given a preliminary examination by the para medical staff and was asked to wait for his turn to see a specialist. And, this waiting stage lasted a full eight hours, during which the only treatment he received was paracetamol twice, for the relief of his pain.

Now, even a lay and completely unlettered person on the street in India, knows paracetamol by its many common brand names and is also aware that it is used only for managing fever and common aches and pains. And, what every doctor in India and the rest of the world, including Canada too, knows is that paracetamol has almost no role in mitigating the pain of a heart attack, let alone doing any good to save the life of a patient afflicted by it. It is simply not a life-saving drug in any scenario. That’s all!

After more than eight hours of waiting, Sreekumar was finally called into the treatment area, where he collapsed within seconds and died.

Denied prompt and specific treatment, his failing heart stopped beating, leaving him dead, ironically at the doorstep of medical treatment.

And, in his dying, he has left behind his grieving wife and three young children, aged three, ten and fourteen, who are unable to understand why their dear dad is no longer with them! This death has drawn much media attention to the Canadian healthcare system, which is reportedly crippled by a severe shortage of doctors, leaving millions of people in the country struggling to access essential primary and specialist care.

And, of these people, a great majority are Canadian citizens themselves, who have been paying steep taxes, that are among other things, meant to keep their Government managed healthcare system alive and ticking. But it has been estimated that their system is at present able to provide prompt emergency care to only thirty percent of the people who need it.

All the others have to wait for varying periods just to get an appointment with the specialist doctors they seek to see and very often this waiting can extend up to two months.

Imagine what this can mean when you have to wait so long, to be seen for an infective fever or a respiratory infection, which if you are lucky may go away on its own. But mind you, if you are unlucky, it can leave you dead and all your other family members infected and dying too.

By any chance, if what you are ailing from is the pain from trying to pass a kidney stone or even a simple toothache, it can leave you feeling like killing yourself, by jumping from the top floor of the hospital where you happen to be waiting!

According to a recent study conducted by the Canadian Medical Association itself, over six million Canadian adults, or about one in five individuals, don’t have access to regular primary care providers like clinics, family physicians and nurse practitioners, let alone to the right specialists.

In the field of emergency medical care, the principle of the “Golden Hour”, or the first sixty minutes after a severe injury or a medical event like a stroke or a heart attack, is critical, as prompt medical intervention during this time can offer the best chance of saving life, preventing complications and ensuring full functional recovery.

Thankfully, this is how things are here at home in India, at present, except in the most remote and inaccessible regions of the country, where the best medical facilities are not yet available in full measure. But the scenario is changing and thankfully, it is changing fast.

Most large hospitals, across our country have the utmost respect for the Golden Hour and even if they are themselves not fully-equipped to provide the required tertiary care, they usually refer patients in need of it to the right destinations, where they can get it promptly. And, very often this is done with the help of reasonably well-equipped ambulances that are staffed by trained personnel.

And, once a patient, young or old, rich or poor, insured or uninsured, accompanied or unaccompanied, reaches the right hospital, he or she can hope to get not only the right kind of pain relief but prompt life-saving treatment. You will not be left unattended and uncared for and that is how good our health care system is.

The bottom line is that you have to reach the right hospital, in right time. And, if a doctor here in India fails to administer prompt and definitive treatment to a patient, for any reason, all hell will break loose, as we see sometimes.

Now, seen from an emergency care lens, the eight-hour long wait in Sreekumar’s case, points to a deeper systemic failure not only in the emergency care delivery system in Canada but in an astonishingly large number of the so called, most developed countries of the world, due to their very peculiar protocols where their entire healthcare is public funded, Government managed and insurance governed.

There is just no room for private hospitals and health care providers to do a far better job than what the Government can do, even if patients are willing to forego this nationalised health service and procure medical care from private players, at their own cost.

Abroad, the hands of doctors are helplessly tied in miles and miles of red tape. As a patient you cannot always select your doctors and your doctors just cannot treat you for a condition they suspect you of ailing from, unless all the protocols of diagnosis, as mandated by medical insurance providers or Government regulations, are established in black and white.

So, if your doctor, backed by sound knowledge and long clinical experience feels that what you have is pneumonia, he or she cannot start the treatment for pneumonia unless all your lab reports and blood counts too say that they are suggestive of pneumonia.

The fact that all patients of a particular ailment may not have all the supporting signs and corroboratory lab results, is just not enough for you to get the right treatment. Failure to comply with these recommendations, which not only seem but are downright stupid, can lead to denial of payments of medical bills by insurance companies and more dangerously, to very expensive and crippling malpractice litigations against doctors.

Thankfully, in India, all patients, insured and uninsured, are very lucky that they can themselves select their doctors, who in turn have complete freedom to administer the treatment they feel is right for their ailments.

On more than one occasion, when our doctors’ medical decisions have been questioned by insurance agencies, our Courts have come to their rescue by delivering landmark judgements that have said, in no uncertain terms, that doctors alone have the complete freedom to administer treatments of their choice for the ailments they see. This is how good the healthcare system is here in India, where the patient’s safety comes first, bypassing all other considerations.

I’m sure that you’ll all agree with me that this is what deserves to be proudly called; The Golden Hour, in a Golden Land!

e-mail: [email protected]