chikitsaalaya

chikitsaalaya - braajeel

chikitsaalaya ya aspataal (hospital) svaasthya ki dekhbhaal karne ki sanstha hai. ismein vishishtataapraapt chikitsakon evam anya staaf ke dvaara tatha vibhinn prakaar ke upakaranon ki sahaayata se rogiyon ka nidaan evam chikitsa ki jaati hai.

anukram

itihaas

aspataal (Hospital) ya chikitsaalaya tatha aushadhaalaya maanav sabhyata ke aadikaal se hi bante chale aae hain. ved aur puraanon ke anusaar swayam Bhagwan ne pratham chikitsak ke roop mein avataar liya tha. 5,000 varsh ya isse bhi praacheen itihaas mein chikitsaalayon ke pramaan milte hain, jinmein chikitsak tatha shalyakovid (surgeon) kaam karte the. ye chikitsak tatha surgeon rogiyon ko rogamukt karne aur unke aartinaashan tatha maanavata ki jnyaaanavruddhi ke bhaavon se prerit hokar swayamsevak ki bhaanti apne karm mein pravrutt rahate the. jyon-jyon sabhyata tatha janasankhya badhti gayi tyon tyon susajjit chikitsaalayon tatha susangathit chikitsa vibhaag ki aavashyakta bhi prateet hone lagi. ataev aise chikitsaalaya sarkaar tatha sevaabhaav se prerit janasamudaaya ki or se khole jaane ka pramaan itihaas mein milta hai. hamaare desh mein door- door ke gaaainvon mein bhi koi na koi aisa vyakti hota tha, chaahe vah ashikshit hi ho, jo rogiyon ko dava deta aur unki chikitsa, karta tha. iske pashchaat aadhunik samay mein tahaseel tatha jilon ke aspataal bane jahaaain antarang (inador) aur bahirang (aautador) vibhaagon ka prabandh kiya gaya. aajkal bade bade nagaron mein aspataal banaae gaye hain, jinmein bhinn-bhinn chikitsa vibhaagon ke liye visheshagya niyukt kiye gaye hain. pratyek aayurvigyaan (medical) shikshan sanstha ke saath bade bade aspataal sambaddh hain aur pratyek vibhaag ek visheshagya ke adheen hain, jo kaalej mein us vishay ka shikshak bhi hota hai. aajkal yeh prayatn kiya ja raha hai ki gaaainvon mein bhi pratyek paaainch meal ke kshetr mein chikitsa ka ek kendra avashya ho.

aspataal ke vibhaag

aadhunik aspataal ki aavashyakataaeain atyant vishisht ho gayi hain aur unki yojana banaana bhi ek vishisht kaushal ya vidya hai. pratyek aspataal ka ek bahirang vibhaag aur ek antarang vibhaag hota hai, jinka nirmaan vahaaain ki janta ki aavashyakataaon ke anusaar kiya jaata hai.

bahirang vibhaag (OPD)

bahirang vibhaag mein keval baahar ke rogiyon ki chikitsa ki jaati hai. ve aushadhi lekar ya maraham patti karavaakar apne ghar chale jaate hain. is vibhaag mein rogi ke rahane ka prabandh naheen hota. yeh vibhaag nagar ke beech mein hona chaahiye jahaaain janta ka pahuainchana sugam ho. iske saath hi ek aapaat (imarajeinsi) vibhaag bhi hona chaahiye jahaaain aapadgrast rogiyon ka, kam se kam, prathamopachaar turant kiya ja sake. aadhunik aspataalon mein is vibhaag ke beech mein ek bada kamara, jismein rogi prateeksha kar sake, banaaya jaata hai. usamein ek or "poochh-taachh" ka sthaan rahata hai aur doosari aur abhyarthak (risepshanist) ka kaaryaalaya, jahaaain rogi ka naam, pata aadi likha jaata hai aur jahaaain se rogi ko upayukt vibhaag mein bheja jaata hai. abhyarthak ka vibhaag uttam prakaar se, sab suvidhaaon se yukt, banaaya jaae tatha usamein karmachaariyon ki paryaapt sankhya ho, jo rogi ko upayukt vibhaag mein pahuainchaaeain tatha usaki anya sab prakaar ki sahaayata karein. bahirang vibhaag mein nimnalikhit anuvibhaag hone chaahiye:

1.chikitsa, 2. shalya, 3. vyaadhiki (paithauloji), 4. streerog, 5. viklaang (orthopeedik), 6. shalaakya (iyar-noj-throt), 7. netr, 8. dant, 9. kshayarog, 10. charm aur ratijrog 11.baalarog (peediyetriks) aur 12. aapatti anuvibhaag

pratyek anuvibhaag mein ek visheshagya, usaka house-surgeon, ek Clark, ek pravidhijnya (tekaneeshiyn), ek kaksh-baal-sevak (ward-bauya) aur ek ardali hona chaahiye. pratyek anuvibhaag nidaanavishesh tatha chikitsaavishesh ke aavashyak yantron aur upakaranon se susajjit hona chaahiye. vyaadhiki vibhaag ki prayogashaala mein nityaprati ki pareekshaaon ke sab upakaran hone chaahiye, jisse saadhaaran aavashyak pareekshaaeain karke nidaan mein sahaayata ki ja sake. vishesh pareekshaaon tatha visheshagyon dvaara pareeksha kiye jaane ke pashchaat hi rog ka nidaan ho sakta hai. aur rog nishchit ho jaane ke pashchaat hi rog ka nidaan ho sakta hai aur rog nishchit ho jaane ke pashchaat hi chikitsa praarambh hoti hai. ataev rogi ko adhik samay tak prateeksha karni padti hai. falat: uske baithane tatha usaki anya suvidhaaon ka uchit prabandh hona chaahiye.

chikitsa - chikitsa sambandhi kaarya do bhaagon mein vibhkt kiye ja sakte hain: (1) nusakhe ke anusaar oshaadhi dekar rogi ke vida karna aur (2) saadhaaran shastrakarm, udvartan, taapachikitsa aadi ka aayojan karna. is kaaran pratyek bahirang vibhaag mein utam, susajjit, kushal sahaayakon tatha narso se yukt ek operation thiytar hona chaahiye. uddhartan, anya bhautikeechikitsa-prakriyaaon tatha prakaash-chikitsaaon ke liye unke upayukt vibhaagon ko uchit prabandh hona chaahiye. isse antarang vibhaag se rogi ko sheegra neerog karke mukt kiya ja sakega aur vahaaain visham rogiyon ki chikitsa ke liye adhik sthaan aur samay upalabdh hoga.

aapad-anuvibhaag - bahirang vibhaag ka ek aavashyak ang aapadanuvibhaag hai. ismein aharnish 24 ghante kaam karne ke liye karmachariyon ki niyukti honi chaahiye. nivaasi surgeon (rejideint-surgeon), nurse, ardali, baalasevak, mehatar aadi itni sankhya mein niyukt kiye jaaeain ki chaubeeson ghante rogi ko unki seva upalabdh ho sake. is vibhaag mein sankshobh (shauk) ki chikitsa vishesh roop se karni hogi. is kaaran is chikitsa ke liye sab prakaar ke aavashyak upakaranon tatha aushadhiyon se yeh vibhaag susajjit hona chaahiye. iski tatparata tatha dakshata par hi rogi ka jeevan nirbhar rahata hai. ataev yahaaain ke karmachaari apne kaarya mein nipun hon, tatha sabhi prakaar ki vyavastha yahaaain ati uttam honi chaahiye. glookoj, plaajma, rakt, taapachikitsa ke yantr, uttejak aushadhiyaaain, injekshan aadi paryaapt maatra mein upalabdh hone chaahiye. yahaaain ex-ai ka ek chalayantr (mobile plant) bhi hona chaahiye, jisse asthibhang, asthi aur sandhi sambandhi vikrutiyaaain fuffus ke ro g ya hrudaya ki dasha dekhkar rog ka nishchaya kiya ja sake. yantron tatha vastron aadi ke visankraman ke liye bhi poorn prabandh hona aavashyak hai. yadi yeh vibhaag kisi shikshaasanstha ke adheen ho to vahaaain ek vyaakhyaan ya pradarshan ka kamara hona aavashyak hai, jo itna bada ho ki samast vidyaarthi vahaaain ek saath baith sakein. shikshakon ke vishraam ke nimitt tatha shikshaasaamagri rakhane aur raatri mein kaam karanevaale karmachaariyon ke liye bhi alag kamre hon. saare vibhaag mein uddhaavan paddhati dvaara shodhit honevaale shauchasthaan hone chaahiye. aise shauchasthaanon ka karmachaariyon tatha rogiyon ke liye pruthak pruthak hona aavashyak hai.

is vibhaag ka sangathan karte samay vahaaain honevaale kaarya, kaaryakartaaon ki sankhya, pratyek anuvibhaag mein chikitsaarthi rogiyon ki sankhya, unki shaareerik aavashyakataaeain tatha bhavishya mein hone vaale anumit vistaar, in sab baaton ka poorn dhyaan rakhana aavashyak hai. pratidin ka anubhav hai ki jis bhavan ka aaj nirmaan kiya jaata hai vah thode hi samay mein kaaryaadhikya ke kaaran aparyaapt ho jaata hai. pehle se hi iska vichaar kar lena uchit hai.

oopar jo kuchh kaha gaya hai usase spasht hai ki bahirang vibhaag mein bahut adhik vyaya karna padta hai. aadhunik samay mein chikitsa ka siddhaant hi yeh hai ki koi chaahe kitna hi nidhan kyon na ho, use uttam se uttam chikitsa ke aayojanon tatha oshadhiyon se apni nirdhanata ke kaaran vanchit na hona pade. is uddeshya ki poorti ke liye kitne dhan ki aavashyakta hai iska sahaj hi anumaan kiya ja sakta hai. sarkaar, deshapremi aur shreesanpann vyaktiyon ki sahaayata se is uddeshya ki poorti asambhav na honi chaahiye.

antarang vibhaag (IPD)

antarang vibhaag mein visham rogon tatha rogi ki avastha ko dekhkar chikitsa karne ka prabandh hota hai. praant, nagar ya kshetr ki aavashyakataaon or vahaaain upalabdh aarthik sahaayata ke anusaar hi chhote ya bade vibhaag banaae jaate hain. thode (das ya baarah) rogiyon se lekar sahasr rogiyon ko rakhane tak ke antarang vibhaag banaae jaate hain. yeh sab paryaapt dhanaraashi or karmachaariyon ki upalabdhi par nirbhar hai. bahut baar dhan upalabdh hone par bhi upayukt karmachaari naheen milte. hamaare desh aur uttar pradesh mein upachaarikaaon (narson) ki itni kami hai ki kitne hi aspataal khaali pade hain. iska kaaran hai madhyam shreni ke parivaaron ki upachaar vyavastha mein aruchi. kuchh saamaajik kaaranon se upachaarikaaon ko bahut achhi drushti se naheen dekha jaata; yeh nitaant bhramamoolak hai. janta ki aisi dhaaranaaon mein tanik bhi auchitya naheen hai.

antarang vibhaag mein bharti kiye jaane ke pashchaat rogi ki vyavasthaaon ka poorn anveshan visheshagya apne sahaayakon tatha vyaadhiki prayogashaala, ex-re vibhaag aadi ke sahayog se karta hai. is kaaran in vibhaagon ko naveenatam upakaranon se susajjit rakhana aavashyak hai. shalya vibhaag ke liye iska mahatva vishesh roop se adhik hai jahaaain karmachaariyon ka daksh hona aur unamein paarasparik sahayog safalta ke liye anivaarya hai. kaksh-baal-sevak se lekar visheshagya surgeon tak sabke sahayog ki aavashyakta hai. keval ek nurse ki asaavadhaani se saara shastrakarm asafal ho sakta hai. ex-re tatha uttam operation theatre is vibhaag ke atyant aavashyak ang hain.

utam upachaar saari sanstha ki safalta ki kunji hai; isi se aspataal ka naam ya badanaami hoti hai. aspataal tatha aadhunik chikitsaapaddhati ka vishesh mahatvashaali ang upachaarikaaeain hain. is kaaran uttam shikshit upachaarikaaon ko taiyaar karne ki aayojana sarkaar ki or se ki gayi hai.

aspataal ka nirmaan

aadhunik aspataalon ka nirmaan engineering ki ek vishesh kala ban gayi hai. aspataalon ke nirmaan ke liye raajya ke medical vibhaag ne aadarsh maanachitr (plaan) bana diye hain, jinmein aspataal ki vishesh aavashyakataaon aur suvidhaaon ka dhyaan rakha gaya hai. sab prakaar ke chhote-bade aspataalon ke liye upayukt nakashe taiyaar kar diye gaye hain jinke anusaar apekshit vistaar ke aspataal banaae ja sakte hain.

aspataal banaane ke poorv yeh bhali-bhaaainti samajh lena uchit hai ki aspataal kharch karanevaali sanstha hai, dhanopaarjan karanevaali naheen. aadhunik aspataal banaane ke liye aarambh mein hi ek badi dhanaraashi ki aavashyakta padti hain; use niyamit roop se chalaane ka kharch usase bhi bada prashn hai. bina iska prabandh kiye aspataal banaana bhool hai. dhan ki kami ke kaaran aage chalakar bahut kathinaai hoti hai aur aspataal ka nimnalikhit uddeshya poora naheen ho sakta:

natvahan kaamaye raajyan na svarg naapunarbhavam.

kaamaye du:khataptaanaam praaninaamaartinaashanam..

hamaara desh ati vistrut tatha usaki janasankhya atyadhik hai. usi prakaar yahaaain chikitsa sambandhi prashn bhi utane hi vistrut aur jatil hain. fir janta ki nirdhanata tatha shiksha ki kami is prashn ko aur bhi jatil kar deti hai. is kaaran chikitsaaprabandh ki aavashyakataaon ke adhyayan ke liye sarkaar ki or se kai baar kametiyaaain niyukt ki gayi hain. bhor committee ne jo sifaarishein ki hain aanake anusar pratyek 10 se 12 sahasr janasankhya ke liye 75 rogiyon ko rakhane yogya ek aisa aspataal hona chaahiye jismein chhah daaktar aur chhah upachaarikaaeain tatha anya karmachaari niyukt hon. yeh praathamik ang kahalaaega. aise 20 praathamik angon par ek maadhyamik ang bhi aavashyak hai. yahaaain ke aspataal mein 1,000 antarang rogiyon ko rakhane ka prabandh ho. yahaaain pratyek chikitsaashaakha ke visheshagya niyukt hon tatha parichaarikaaeain aur anya karmachaari bhi hon. ex-re, raajayakshma, surgery, chikitsa, vyaadhiki, prasooti, asthichikitsa aadi sab vibhaag pruthak-pruthak hon. maadhyamik ang se pare or usase bada, keindreeya ya jile ka vibhaag ya ang ho, jahaaain un sab prakaar ki chikitsaaon ka prabandh ho, jinka prabandh maadhyamik ag ke aspataal mein na ho. yahi par sabse bade sanchaalak ka bhi sthaan ho.

is aayojan ka samast anumit vyaya Bhaarat sarkaar ki sampoorn aay se bhi adhik hai. is kaaran yeh yojana abhi tak kaaryaanvit naheen ho saki hai.

vishshti aspataal

aajkal janasankhya aur usi ke anusaar rogiyon ki sankhya mein vruddhi hone se vishesh prakaar ke aspataalon ka nirmaan aavashyak ho gaya hai. pratham aavashyakta chhutahe rogon ke pruthak aspataal banaane ki hoti hai, jahaaain keval chhutahe rogi rakhe jaate hain. isi prakaar raajakshma ke rogiyon ke liye pruthak aspataal aavashyak hai. maanasik rog, asthirog, baalarog, streerog, prasootigruh, viklaangata aadi ke liye bade nagaron mein pruthak aspataal aavashyak hain. chhote nagaron mein ek hi aspataal mein kam se kam bhinn-bhinn apekshit vibhaag banaana aavashyak hai. in aspataalon ka nirmaan bhi unke aavashyakataanusaar bhinn-bhinn prakaar se karna hota hai aur usi prakaar vahaaain ke karmachaariyon ki niyukti ki jaati hain. in sab prakaar ke aspataalon ke maanachitr tatha vahaaain ki samast aavashyakataaon ki soochi sarkaar ne taiyaar kar di hai, jinke anusaar sab prakaar ke aspataal banaae ja sakte hain.

vishraam vibhaag

bade nagaron mein, jahaaain aspataalon ki sada kami rahati hai, ugr avastha se mukt hone ke pashchaat, durbal svaasthyonmukh vyaktiyon tatha atyadhik samayasaadhya chikitsaavaale rogiyon ke liye pruthak vibhaag-rugnaalaya (inafrmari)-banaana aavashyak hai. isse aspataalon ki bahut kuchh kathinaai kam ho jaati hai aur ugraavastha ke rogiyon ko rakhane ke liye sthaan sugamata se mil jaata hai.

chikitsaalaya aur samaajasevak

aajkal samaajaseva chikitsa ka ek ang ban gayi hai aur dinon-din chikitsaalaya tatha chikitsa mein samaajasevi ka mahatva badhta ja raha hai. aushadhopachaar ke atirikt rogi ki maanasik, kautunbik tatha saamaajik paristhitiyon ka adhyayan karna aur rogi ki tajjanya kathinaaiyon ko door karna samaajasevi ka kaam hai. rogi ki rogotpati mein usaki rugnaavastha mein uske kutunb ko kin kathinaaiyon ka saamana karna pad raha hai tatha rog se ya aspataal se rogi ke mukt ho jaane ke pashchaat kaun-si kathinaaiyon ka saamana karna padega, unka rogi par kya prabhaav hoga aadi rogi ke sambandh ki ye sab baatein samaajasevi ke adhyayan aur upachaar ke vishay hain. yadi rogamukt hone ke pashchaat vah vyakti arthasankat ke kaaran kutunbapaalan mein asamarth raha, to vah pun: rogagrast ho sakta hai. rogakaal mein uske kutunb ki aarthik samasya kaise hal ho, iska prabandh samaajasevi ka kartavya hai. is prakaar ki pratyek samasya samaajasevi ko hal karni padti hai. isse samaajasevi ka chikitsa mein mahatva samjha ja sakta hai. ugr rog ki avastha mein upachaarak ya upachaarika ki jitni aavashyakta hai, rogamukti ke pashchaat us vyakti ke svaasthya ki raksha tatha jeevan ko upayogi banaane mein samaajasevi ki bhi utani hi aashyakata hai.

aayurvaijnyaaanik shikshaasansthaaon mein aspataal-aayurvaijnyaaanik shiksha sansthaaon (medical kaalejon) mein chikitsaalayon ka mukhya prayojan vidyaarthiyon ki chikitsa-sambandhi shiksha tatha anveshan hai. is kaaran aise chikitsaalayon ke nirmaan ke siddhaant kuchh bhinn hote hain. inmein pratyek vishay ki shiksha ke liye bhinn-bhinn vibhaag hote hain. inmein vidyaarthiyon ki sankhya ke anusaar rogiyon ko rakhane ke liye samuchit sthaan rakhana padta hai, jismein aavashyak shayyaaeain rakhi ja sakein. saath hi shayyaaon ke beech itna sthaan chhodna padta hai ki shikshak aur uske vidyaarthi rogi ke paas khade hokar usaki parreeksha kar sakein tatha shikshak rogi ke lakshanon ka pradarshan aur vivechan kar sake. is kaaran aise aspataalon ke liye adhik sthaan ki aavashyakta hoti hain. fir, pratyek vibhaag ko poornataya aadhunik yantron, upakaranon aadi se susajjit karna hota hai. ve shiksha ke liye aavashyak hain. ataev aise chikitsaalayon ke nirmaan aur saganthan mein saadhaaran aspataalon ki apeksha bahut adhik vyaya hota hai. shikshakon or karmachaariyon ki niyukti bhi keval shreshthatam vidvaanon mein se, jo apne vishay ke maanya vyakti hon, ki jaati hai. ataev aise chikitsaalaya chalaane ka nityaprati ka vyaya adhik hona svaabhaavik aisi sansthaaon ke nirmaan, sajja tatha karmachaariyon ka poora byora Indian medical kaaunsil ne taiyaar kar diya hai. yahi kaaunsil desh bhar ki shikshaasansthaaon ka niyantran karti hai. jo sanstha uske dvaara nirdhaarit maapdand tak naheen pahuainchati usako kaaunsil maanyata pradaan naheen karti aur vahaaain ke vidyaarthiyon ko uchch pareekshaaon mein baithane ke adhikaar se vanchit rahana padta hai. shiksha ke star ko uchchatam banaane mein is kaaunsil ne stutya kaam kiya hai.

aise aspataalon mein vishesh prashn paryaapt sthaan ka hota hai. kamron ka aakaar aur sankhya donon ko hi adhik rakhana padta hai. fir, pratyek vibhaag ki aavashyakta, vidyaarthiyon aur shikshakon ki sankhya aadi ka dhyaan rakhakar chikitsaalaya ki yojana taiyaar karni padti hai. (chan.bha.sin.)

Bhaarat ke pramukh aspataal

baahari kadiyaaain