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September '07: Of Public Health

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Of Public Health

When we talk about citizens and their rights, one has to look at the ``servicesĒ that are available to them in their country to protect their rights. Fr instance, good health care is a basic right of the citizen and a number of countries have various ways of providing good health care facilities to their citizens. In Pakistan , tax payers money is used to run government hospitals. However, what are the conditions in these government hospitals? This issue of individu-spotlight focuses on this. As always, feedback will be most welcome.
An apple a day keeps the doctor away but if you havenít been following this advice and do end up at a government hospital in Pakistan what will you find?The answer to this question is not very encouraging .

Conditions in the state run civilian hospitals are inhospitable to say the least. Whether it is Jinnah hospital in Karachi, Mayo hospital in Lahore, Bolan hospital in Quetta or Lady Reading hospital in Peshawar the conditions are roughly the same.

Entering the Jinnah hospital, Karachi Gynae/Obs ward recently was a sad experience .To start with, the fly spoofing in the corridor that leads to the wards is torn sending an irresistible invitation to all sorts of flies and mosquitoes to feast upon. The toilets were in a dismal state as was revealed in a recent media report on the hospital. The poor patients and their attendants, however, are constrained to use these pits of infection. The washbasins have not been cleaned since their installation and are badly in need of a chemical wash. The wards were untidy and some of the beds were without sheets.

A doctor on condition of anonymity remarked that the wards present a different picture in the morning at the time of rounds of senior doctors.' Unfortunately, the moment the senior doctors leave, the staff becomes negligent and carries out their duties in a slipshod manner .I want to add here that our patients come from very poor backgrounds and have no concept of hygiene or even of using the toilets properly. So the janitors have a hard time in maintaining cleanliness.'

JPMC is in a need of a new ward in the hospital's maternity wing to cater to the newborns of the cats that prowl the Gynae ward .A doctor there was very critical of the paramedical staff.

'They don't do their duty unless they are bribed. For moving the patients from wards to labor room, they charge money.' she said. 'Guards at the gates charge money to let in the males. This is very disturbing for patients undergoing various stages of pre and postnatal stages. Yet they are helpless and bear this transgression quietly.'

Another hospital that was recently put under media spotlight was Sobhraj Hospital in Karachi. Established in 1920, Sobhraj Hospital lies in the heart of the city. According to a nurse at Shobhraj, about six hundred babies are born every month at the hospital. To look after the expectant mothers and their offspring, only one trained nurse and three novices are employed. According to a doctor there,' New born babies are not even examined by pediatricians. Nurses examine them and do suction to clear the throat of the baby in a place which is filthy.'

Letís turn to Peshawar where one of the leading and busiest hospitals there is the Lady Reading Hospital. A total of hundred thousand patients enter daily through only one gate of the hospital. The conditions that these patients find here are not so different from the ones found in government hospitals anywhere else in country. Perhaps that is why in December 2006, vigilance cameras were installed at Lady Reading Hospital, Peshawar. According to the administration the reason why these cameras were installed was to check performance of health staff and ensure their presence, discourage tout culture and to keep an eye on anti-social elements ' .These vigilance cameras were installed inside the hospital. All six secret cameras started functioning after the then Chief Executive of the Hospital Prof Dr. Abdus Samad Khan inaugurated it.

In the first phase, cameras were installed at all OPD units which the hospital administration argued was important as most of the people after entering the hospital premises usually go there. The LRH administration declared at that time that installation of cameras would ensure the presence of the hospital staff in their respective positions and will also help in controlling touts in the OPD.Besides this, it was also declared by the Chief Executive that it would help in keeping an eye on anti social elements and practices in the OPD.Some people at that time had drawn attention of the hospital administration towards bad lighting arrangements in the OPD which in their opinion would make it hard for the monitors to identify people. However, the technical experts who were given the task of installing the cameras had assured the administration at that time that they would remove such faults soon. Such a facility was also on the cards to be extended to the administration block also.

However what perhaps the administration and the technical experts had not taken into account was the ingenuity of simple thinking. The vigilance cameras are a failure. Not because of poor lightning or any other reason. But because the paramedical staff who realized that the cameras were being used to keep an eye on them, covered the lens with a rag! The hospital administration has interestingly turned a blind eye [no pun intended] to the fact that the camera eye has been obstructed.

A number of sorry tales can be narrated about the conditions prevalent in Lady Reading but such conditions are the same in civilian public funded hospitals all over the country. One factor for this is that there is tremendous patient load on the hospitals infrastructure.

Speaking on condition of anonymity, a doctor at Lady Reading hospital declared that`` ideally the district hospitals should be well equipped so that they handle the preliminary problems and then refer the patients to us for tertiary care. The problem is that the referral system is not in place with the result that everyone comes directly to a tertiary care hospital like Lady Reading in Peshawar.Ē

Perhaps that is why Pakistanís health indicators leave a lot to be desired. Pakistanís major health indicators demonstrate large unmet needs. The total fertility rate is 4.8, contraceptive prevalence is only 28%, and the population growth rate is 2.2% per year (compared with Indiaís 1.7%). Estimated infant mortality is 85 per 1000 live births, less than five mortality is 103 per 1000 live births, and maternal mortality is 533 per 100,000. Immunization rates are low with less than 60% of one-year olds fully immunized. Twenty-six percent of children under five are moderately to severely underweight; only 1% of young children receive vitamin A supplementation; and only 19% of households use iodized salt.

It will be unfairly simplistic to blame doctors or other members of the medical community for the state of health facilities all over the country. The medical community as a whole is struggling to provide a service under very challenging circumstances .Regularly there are instances in Lyari Hospital,Karachi for instance of relatives of a deceased beating up doctors and other staff on their alleged negligence. Conversations with doctors revealed that although there are cases where doctors are at fault but it is also important to remember that there are also several instances when the patient is brought to the hospital in such a state that doctor cannot do much to help. The family then gets enraged and ugly scenes between the patientís family and the doctors are seen.

All said and done when one casts a cursory glance at the health facilities in the country, one can only wish that the apples kick in to keep us healthy.



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