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Chitrals collapsing health system
-letter3
“Meet Professor “X”,
Prof: of Medicine. He is a busiest physician of the
town. He examines at least three patients a day”.
This happened when a class fellow of mine was
wandering in a hospital in a civilized country,
along with his companion.
This is international standard for examining and
treating ailing humanity. I always go home
dissatisfied from my office, because I always fail
to satisfy the mob of patients. In the allocated
time it is not possible to thoroughly check 60 to 70
patients. The ethnocentrism of the attendants,
augmented by non-conducive atmosphere, UN trained
human resource agitates the doctor, who, in spite of
being cream of the society and highly qualified are
overburdened and underpaid. Sometimes being
compelled by the attitude of the attendants they
react harshly, which is natural phenomenon.
For the last eight years we are producing half a
dozen male and female doctors per year but non of
them opt to come to Chitral due to the menace of
contract system and meager salary. Instead, thy get
self-employment and improve their qualification else
where in the country.
Those, who are already serving here, go to the
teaching Hospital to improve their knowledge and
skill or for specialization, after their tenure are
over. As a result the number of doctors working in
Chitral has come down to 35 as compared to 78 in
Nineties. At the DHQ and THQ level, one doctor is
performing the job of three to four.
This is pertinent to mention here that after the
devolution of power the distribution of resources is
made on the basis of PFC awards i.e. on the basis of
population. The allocation of budget to the health
institutions is so meager that one feels ashamed to
mention it in front of fellows from big and populous
districts. this has further deteriorated the already
dilapidated conditions of the health institutions.
The allocation of budget is less than 12 rupees per
patient per year, what to talk of other facilities
for the Health Care Providers.
Those who have seen DHQ Hospitals in other Districts
will salute their sons and the management of the
health department of Chitral. I would advise Humera,
who seems to be well off, to go around the 26
District Head Quarter Hospitals of the Province and
compare the availability of the staff round the
clock, cleanliness, behavior of the HCPs and then
compare them with your own DHQ Hospital.
I feel shocked if some body compares this Hospital
with the Agha Khan University Hospital , LRH, KTH,
HMC and AMC.Please compare this hospital with its
equivalent Institutions, you will feel proud of it.
As far as commitment of the doctors is concerned,
this letter shows total ignorance of the writer
about the district.Chitral is considered one of the
top districts of the country as far as its vertical
programs are concerned and their indicators speak
loud of the commitment of the doctors.
Humera has eulogized the services of BMC. Yes, it is
an asset of this district. But in spite of its state
of the art building, facilities available there,
behavior of the staff, the flow of patients is less
than 1/3rd of the THQ Hospital Booni.Go and see,
this hospital (THQ) is devoid of every thing, even
faces scarcity of drinking water, a basic human
need, one or two doctors, paramedics with sad faces
and grown beards, no arrangements to cope with the
freezing cold but sizeable number of patients
sitting on benches, standing in ques. What this
tells us? Yes, this is a slap on the face of the
lobby, working for privatizing the health
institutions and depriving the poor masses of at
least free checkup by a qualified doctor at a cost
of only three rupees and operations related to
almost all specialities, which otherwise would have
cost them in thousands in the private sector. Other
institutions run by various NGOs give deserted look
after 11 am , the patient’s flow on DHQ and THQs
has increased and exerting pressure on their
resources and infrastructure due to failure to
attract qualified doctors for the BHUs, Health
Centers run by the private sectors.
These mischievous people are fond of floating the
idea of privatization at least twice a year, with
the support of incompetent persons, who are
otherwise burden on the Government exchequer and
after failing to manage their own institutions,
start such monkey business.
This, may still be in the memory of some people that
after rendering sacrifices the doctors community has
saved health institutions in the province from being
handed over to the contractors in 1988, in spite of
the fact that 20% of the total income of the health
institutions, after privatization was promised to be
distributed among the doctors and other staff. Had
this step being in the interest of the masses,
leadership of the province (all parties), including
journalists, ulemas and other opinion makers would
not have supported the movement launched by the
doctors community.
As far as posting some body from outside the medical
profession, as an administrator of the health
institutions is concerned, it is just like handing
over ATR to a Rickshaw driver. Just think! What
would be the fate of the passengers and the
aircraft? There are thousands such examples left,as
a result of such blunders in the province in general
and in Chitral in particular.
Dr.Noor- ul- Islam
Chitral.
31 March 09.
Chitrals collapsing health system
-letter2
This is with reference
to Ms Humera's letter published in Chitralnews on
March 22, 2009 on the subject cited above. I
appreciate the writer's critical view and analysis
of the conditions of health facilities and services
in the government hospitals in Chitral. It is very
sad that the government hospitals having the mandate
of providing quality health care to the masses of
Chitral are lacking basic facilities and
professional doctors.
However, I do not agree
with the writer's proposition that handing over
government hospitals to the Aga Khan Health Service
(AKHS) Chitral would be the "solution" to the ailing
health system in Chitral. I do agree that AKHS has
done an excellent job by establishing the Booni
Medical Centre, the Extended Family Health Centre in
Shoghore, Enhancing the capacity and management of
Shahgram BHU, and many health centres in remote
villages in Chitral.
However, the AKHS also
has its own problems. The writer has mentioned the
Booni Medical Centre as a success story of AKHS but
she has not discussed the Extended Family Hospital
in Shoghore which shows AKHS failure in providing
quality health service and hospital management. AKHS
has made huge investment in constructing the state
of the art building and providing very expensive
equippments at this particular hospital but has
failed to make it function.
Ms Humera has also mentioned of malpractices by the
leadership in government health system which I agree
with but I wonder if AKHS is free of such
malpractices.. The recent recruitment of candidates
by AKHS for midwifery and nursing training in
Chitral was, in popular perception, not merit-based.
many candidates and their parents have revealed that
most of the candidates selected for this training
were either the relatives of AKHS officials or
backed by affluent people in Chitral.
The question then arises
of where is the solution to the ailing health system
in Chitral? Handing over the management of one
institution to another institution may not be a
viable solution to this problem- the viable solution
should come from within the institution.
Saifullah Khan
Arkari, Chitral.
24 March 09.
Chitrals collapsing health system
-letter
The biggest problem
confronting Chitral since time immemorial has been
health care. With a view to rationalizing the lack
of health facilities, a mindset was promoted whereby
ailing people were made to believe that hospitals do
not give life but God does. This in turn encouraged
the tendency of faith healing and talismans. Even
the emergence of modern health care facilities
failed to motivate the people to change their
mindset, part of the reason being disinterested and
careless handling of patients by the doctors, which
in some cases led to complications resulting in the
death of patients suffering from treatable diseases.
The doctors defend
themselves by saying that patient load and
inadequate diagnostic facilities handicap them to
properly treat patients. However this argument is
belied by many examples in one case a patient with
swelling body was brought to a hospital, where
doctors diagnosed them a diabetic, heart patient,
lung, liver and kidney malfunction and advised him
to seek specialist treatment elsewhere. The patient
was taken to AKU where the patient was treated
outdoor for kidney infection and recovered in three
days. With some care and application of mind this
patient could have been treated and saved from
incurring avoidable expenditure which brought him
into indebtedness.
In another case a
patient suffering from stomach ulcer was treated for
another ailment that he did not have. When the
patient protested over this mishandling, the doctor
shouted him down and the patients relatives took
him to Aga Khan Hospital Booni, where he was
operated upon for ulcer and recovered.
There is a cynical
view which says that doctors working in Government
set up deliberately mishandle patients, so that
private clinics are made to flourish in the process.
Some people even question the bone fide of medical
degrees given the level of malpractices in our
education system. I do not subscribe to this cynical
view because as Muslims we are bound to keep our
promises a medical doctor takes Hippocratic Oath to
save lives. In view of this how can he go against
this oath later on, unless he has no faith? Given
proper supervision, accountability and monitoring,
the situation could be improved.
The medical
superintendents are happy with their perks and
choose not to supervise their doctors. If some one
from outside the medical profession is to be posted
as M.S for better administration, doctors might gang
up to defend their turf. It was for this situation
that Winston Churchill said every body for himself
and God for all.
Recently few stakeholders have come up with the idea
that Govt. hospitals in Chitral should be given
under private management by invoking the principle
of public- private partnership. The health sector
mafia would resist this proposal, although there is
no other option. Public sector hospitals are simply
incapable to reform themselves and the Govt. is
incapable to take decisive action to improve the
situation and the leaderless general public is
groping in the dark in the hope of finding a saviour.
In this situation of hopelessness and helplessness,
a vague hope has emerged with the expected decision
of the Govt. to hand over THQ hospital Garam Chashma
to Aga Khan Health Service as a pilot project. It is
hoped that this policy will be extended to other
hospitals It is now for the AKHSP to make this
experiment a success and for this they have to learn
lessons from their past mistakes and decisions to
sustain this arrangement and for this to happen
people of vision, doctor or otherwise, must man key
positions in AKHSP. The success of Booni Medical
Centre and the dedication of its staff give us
reason to hope that AKHSP will succeed where the
Govt. has failed, although its Shoghore Hospital
gives us cause for concern that some of its
decisions may be motivated.
Meanwhile some emergency steps are required to
improve the situation at DHQ level. It is the
biggest out lift but lacks some key facilities like
Coronary care, Psychiatry Nephrology and urology etc
which are most common disease in Chitral. It has no
provision for clean drinking water and remained
without electricity throughout this winter. Its
generator has no diesel. Patients are treated under
torch light. Surgery can only take place when a
patient can pay for the generator. There is no sense
of hygiene in the hospital. Patients are given
symptomatic treatment which often complicates
ailments. Had there been no Al-Khidmat Foundation
diagnostic centre many more patients would have
died.
Doctors generally lack sense of commitment with
their profession and prefer to be posted out in
cities or on administrative posts. Paramedics do
their job with disdains and their reports are not
relied upon even by their own doctors. This
situation has turned official claim of free
treatment into a myth. Medicines either expire or
find their way to the market and patients are left
with no option except to buy their medicines from
the open market. Most of the time expensive
medicines are prescribed to please representative of
pharmaceutical companies.
Yes there are good doctors but few black sheep spoil
their image. The administration of hospitals and the
District Govt. have failed to come up to public
expectations. The mandatory provision providing for
monitoring committees has yet to be honored. It is
all the more painful that this situation has been
allowed to persist in a District which remains cut
off from the rest of the country for seven months in
a year and patients can not be taken to cities for
treatment.
This being the ground situation, one doubts the
mental state and honesty of our elected
representatives, past and present, when they claim
to have served Chitral. We should be ashamed of
ourselves that in 60 years we have failed to secure
our basic health needs. The degenerating education
system, collapsing infrastructure, illegal
occupation of state lands(1975 notification),
disappearing forests and wildlife, melting glaciers
glaciers, misuse of development funds, complete lack
of accountability and the culture of impunity are
living testimony of the ways that our leaders and
the many NGOs have served Chitral.
It is a measure of our
leadership crisis that our so called leaders feel
elevated after posting or transferring a petty
official or giving lucrative post to a relative or
favourite or hurting an opponent and fail to attend
to problems facing the general public. It is
unfortunate that gurus of our misfortune still
continue to rule over us and are enjoying support of
the Government as well as NGOs
Humera,
Chitral.
22, March 09
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