Billions for hospitals, roads

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Billions for hospitals, roads

KARACHI: The City District Government Karachi (CDGK) will start 50 new major development schemes in the next fiscal year 2007-08, according to budget documents, to use up Rs 45.6 billion.

The Tameer-e-Karachi Programme has been allocated Rs 5.3 billion for goth development, roads, bridges, flyovers, drains, crisis centres, solid waste, and the water supply master plan. The CDGK is going to contribute Rs 320 million to the Citizens Community Boards and Rs 100 million to the Gutter Baghicha Park project, besides initiating the construction of Jheel Park (Rs 100 million) and Kite Park (Rs 100 million). For other CDGK parks, Rs 131.62 million has been set aside.

In the health sector Rs 95 million has been allotted for new wards in Abbasi Shaheed Hospital, while Rs 176 million and Rs 137.5 million have been allocated to the Karachi Medical and Dental College (KMDC) and the Karachi Institute of Heart Diseases (KIDH) respectively. Furthermore, Rs 75 million is to go towards developing a health management information system for the KIHD.

Other major development projects include Karachi Elevated Expressway (Rs 1.35 billion), development in all union councils (Rs 1.6 billion), development of inter-city, town and union council roads and intersections (Rs 155 million).

(Daily Times-B1, 01/07/2007)

Voices told me to castrate myself’

KARACHI: A 30-year-old man has landed in hospital after cutting off his own genitals with a blade which he claimed he did after he heard voices in his head telling him he was a “eunuch”. Zahoor, a resident of Saeedabad who appeared educated, told Daily Times from his hospital bed Saturday that the voices he heard in his head had been disturbing him a lot. As soon as he castrated himself, neighbours rescued him and took him to the Edhi centre at Mereweather Tower from where he was rushed to Civil Hospital. Emergency ward chief Dr Tariq Ayubi, who treated Zahoor himself, said that he had seen up to 30 such cases in his career. Ayubi said that the bleeding stopped after a while. Zahoor’s urination will not be affected. He will require constant dressings for the next few days and plastic surgery may be required. Zahoor told doctors that he abused a certain medication and that he had cut his penis off and thrown it near Mereweather Tower. He said he did not feel that much pain and would just need a slight painkiller. He has been admitted to the urology department. According to Ayubi, three broad categories of people do this: The first are the psychiatrically ill, the second are victims of family conflict and the third are those men who are apparently frustrated by their wife’s accusations. Last year, a government official in the Punjab castrated himself due to a misunderstanding with his wife, according to sources at Civil Hospital.

(Daily Times-B1, 01/07/2007)

Illegal kidney sales

POLICE in Lahore have detected at least 10 hospitals, in addition to three others charged with illegal organ trade, engaged in kidney transactions. The task of eliminating the sale and purchase of organs is proving difficult in the absence of a proper law regulating organ donation. As long as our legislators dawdle over the passage of a draft ordinance seeking to curb the organ racket, the scourge of kidney sales will continue. Such transactions are no longer confined to the poor selling a kidney in order to escape their ever-mounting debts. Kidneys are now being extracted from unsuspecting individuals who are kidnapped for this purpose. There have also been cases where people admitted to hospital for surgery have been deprived of a kidney on the operating table. This trend is bound to continue as the absence of legislation is encouraging unethical doctors and middlemen to join forces and make a killing in the process.

While the endless wait for a transplant law continues, concerned doctors, the media and civil society members can do much to promote the idea of cadaver donation among the public. Inhibitions based on religious beliefs can be overcome by pointing out that a number of Muslim countries approve of cadaver donation. Health fears, too, can be tackled by pointing out to close relatives of renal patients that it is possible to lead a full life on one kidney. Creating such awareness is important in a country where thousands of kidney patients require transplants. Such public knowledge will also deter hospitals from indulging in unethical practices. However, much depends on when — and with what changes to the existing draft — the law is enacted. The police need a legal instrument for swooping down on errant hospital administrations and individuals, and without this, the organ trade will not be brought to an end.

(Dawn-7, 04/07/2007)

Gastroenteritis isn’t a rich man’s disease, doctors say

KARACHI: The Abbasi Shaheed Hospital has been registering an average of 15 to 20 gastroenteritis patients from poor localities a day since last week’s monsoons in the city, the hospital’s casualty coordinator Zulfiqar Ali told Daily Times Tuesday. Prior to the current outbreak, the hospital registered one to two gastroenteritis patients daily, “and then too, it was mostly the patient’s own fault. Dirty water tanks, etc, were major reasons for the disease,” Ali said.

The patients coming in right now are divided into two categories. Those with chronic gastroenteritis are admitted to the hospital, while the rest are discharged by the casualty department. Children below the age of 12 are sent to the paediatrics department, Abbasi Shaheed Hospital AMS Dr Syed Javed Akhtar said.

The hospital’s paediatric department received 31 patients on July 1 and 32 patients on July 2, all of who were admitted for observation. The casualty department (for patients above the age of 12 years), on the other hand, admitted four patients on July 2.

The casualty department has been divided into three on-call teams to deal with the current outbreak of gastroenteritis. The medicine unit-1 is on call Mondays and Thursday, the medicine unit-2 is on call Tuesdays and Fridays, and the medicine unit-3 is on call Wednesdays and Saturdays. The teams rotate on Sundays, Dr Akhtar said.

Most of the patients come in from lower-income areas, the AMS said, adding that a majority of the gastroenteritis patients admitted at the hospital on July 2 came from Orangi Town, Liaquatabad, and New Karachi. “Sewerage seeps into pipes that carry drinking water, and that is a major cause for the disease,” Dr Akhtar said. “We hardly ever get any gastroenteritis patients from ‘affluent’ suburbs.”

During the rainy reason, the Rota virus transmits this disease in children, he said. “A different set of virii are responsible for gastroenteritis in adults. The symptoms, however, are the same in all patients: vomiting, ‘loose motions,’ and high fever. The intensity of the fever depends on the amount of dehydration caused by the excessive defecation. The more the dehydration, the higher the fever will be,” Dr Akhtar said. “We have not had any casualties at the hospital yet, however.”

Precautionary measures against gastroenteritis include using either boiled water or mineral water, the AMS said. In addition to this, fruits and vegetables should be washed with warm water, food from outside should be avoided, and feeders for babies should be sterilised. “We encourage breastfeeding, though, and the stupid habit of giving pacifiers to children should be ended. They’re unhygienic, and are major causes for stomach diseases in children,” he said. A mother suffering from gastroenteritis will not transmit the disease to her child through breastfeeding, Dr Akhtar maintained.

Doctors on duty at the Liaquat National Hospital (LNH), on the other hand, maintained that they have received very few gastroenteritis patients “if at all” during the current outbreak. “Gastroenteritis is not a disease of the affluent,” they maintained. “People who generally get it cannot afford to come to LNH. They will go to government hospitals.” The head of the gastroenteritis department, Dr Pervez Ashraf, was not available for comment.

No one was available to answer gastroenteritis-related questions at Jinnah Postgraduate Medical Centre (JPMC) either. Moreover, the hospital has not been reporting gastroenteritis statistics to the Sindh government’s monitoring cell, Sindh Deputy Health Secretary Dr Shakeel Malik said.

(Daily Times-B1, 04/07/2007)

Little stress on women’s health

By Zubeida Mustafa

MORE appalling than the state of the reproductive health of women in Pakistan is the ignorance shown by our policymakers and leaders of opinion about the silent suffering of women.

Dr Shershah Syed, the president of the Society of Obstetricians and Gynaecologists of Pakistan, who is one of the most outspoken critics of the government’s health policy, recalled the other day his encounter with political leaders before the 2002 elections. The PMA had arranged a meeting with party representatives to brief them about women’s health. Thus the doctors hoped to enlist the cooperation of the prospective parliamentarians in health matters after the election.

He was shocked when most leaders refused to believe the statistics he gave about maternal mortality. They rejected promptly the grim picture he painted as a lie. They alleged that he was exaggerating when he told them how women were suffering due to the inadequate facilities available for maternal and neonatal health.

The fact is that reproductive health has been a subject that has been shoved under the carpet. Until recently it was not even discussed openly – thanks to the prudishness and hypocrisy of our society – and there was little public awareness about it. The situation changed somewhat when Benazir Bhutto in her second term as prime minister set up the National Committee on Maternal and Neonatal Health (NCMNH) in 1994 with Dr Sadiqa Jafarey as the president. It was mandated to “analyse the problem of high maternal mortality and morbidity in the country and develop and demonstrate workable approaches with the objective of lowering the high rate of maternal deaths.”

This proved to be an uphill task. Dr Sadiqua Jafarey, the president of NCMNH and one of the most senior gynaecologists in the country who has devoted her entire working life to the cause of women’s health, says it is difficult to say whether the committee has made any impact on the maternal mortality rate (MMR) because there is no benchmark for it to follow. The National Institute of Population Study, Islamabad, has now conducted a survey the results of which are awaited.

“Our experience has been that the MMR in all major tertiary care hospitals has remained unchanged. But that could be due to growing awareness and more women with complications being brought to hospitals which neutralises any drop that might have occurred.”

Dr Jafarey feels that the NCMNH’s greatest achievement has been to create public awareness of the importance of women’s reproductive health in Pakistan. At least the issue is now being discussed and last week her committee focused its consultation on unsafe abortions, which are one of the major causes of maternal mortality after haemorrhage, sepsis, eclampsia and obstructed labour.

The NCMNH has shown the courage and foresight to bring the problem of unsafe abortions into the open since nearly a tenth of maternal deaths in the country take place as a result of the complications caused by the dangerous termination of pregnancies by unskilled dais.

Thanks to the NCMNH’s efforts the government announced in April 2005 the National Maternal and Child Health Policy and Strategic Framework (2005-2015) and an implementation programme last year.

This document focuses on the health interventions which are essential to save the lives of expectant mothers. Recognising the fact that most babies in Pakistan are born at home without any skilled supervision, the government seeks to train midwives, birth attendants and lady health visitors who work in the community. It has also been realised that inadequate emergency obstetric and neonatal care facilities in hospitals is also responsible for a high MMR – estimated to be 500 per 100,000 live births in Pakistan by the UNFPA’s State of the World Population, 2007.

The government has earmarked Rs31.5 billion to be spent in five years on this programme. Will this amount be forthcoming? The policy acknowledges that Pakistan spends too little on health – only 0.65 per cent of GDP. The internationally recommended figure is two per cent of GDP.

Another important factor that has been recognised but has not been addressed is the socio-cultural and economic causes of maternal mortality. The poor reproductive health of women in Pakistan reflects their abysmal status. When resources are scarce – be it in the national exchequer or in the family budget – it is taken for granted that the cuts will be exercised on the spending on women, be it their healthcare or education.

Closely linked to maternal health is the performance of the population programme. It may be designed primarily to prevent births and thus reduce the population growth rate, but the population programme has a direct bearing on maternal health by regulating the family size and the spacing of children. For it is now known that a woman’s reproductive health is determined to a large extent by the number of pregnancies she has had and the gaps between them. These are in turn influenced by the availability of contraceptives.

The contraceptive prevalence rate in Pakistan is dismally low (a paltry 20 per cent) and as a result there is a high unmet need. In other words, there are far too many women who are burdened with unwanted pregnancies because they have no access to birth control measures. It is a myth that people’s religious beliefs come in the way of planned parenthood.

Denying them contraceptive choices and facilities is at the root of our failed population programme which should be integrated closely with the maternal healthcare strategy – as Dr Nafis Sadik, the previous executive director of the UNFPA, never tired of recommending.

All these interrelated factors play on each other and multiply the impact of every factor. The need is to break the vicious cycle. This would explain why countries which show a low MMR also have a high contraceptive prevalence rate and a high literacy rate among women.

Will our policymakers respond to the challenge they face? They will have to show their commitment to women’s rights by translating it into better maternal and child health as laid down by the millennium development goals.

(By Zubeida Mustafa, Dawn-7, 04/07/2007)

Children suffer at NICH Gastro Ward
Gastro Ward at the National Institute of Child Health (NICH) is chock-full. There are around 20 beds in this ward, but there are at least two children sleeping on one; their mothers sitting, fanning themselves, head resting on their hands, silently worrying about the fate of their children.

From time to time, they glance at their sleeping infants, and strike the cheeks or hair, or slip their large adult fingers in the small, delicate baby fist.

Naima, a two-year-old child sleeps soundly as her mother, Yasmin, sits next to her on the bed.

“It has been one week since my child has been ill,” says Yasmin. “It started with vomiting and then led to diarrhea and since then I have not seen her getting any better even though the doctors say she is improving.”

Yasmin says the water they use in the house is bought at Rs 3 per canister (30 liters), which is what they use for drinking, but she is not clear where the water comes from, and whether it is safe or not.

Though Naima’s case is bad, there are worse cases in the hospital. One-year-old Ammad has been constantly shifted from one hospital to another. Now he lies at NICH, sharing a bed with another baby, faint with weakness and dehydration. His mother says that he fell ill three or four days ago, but at six in the morning of July 3, she says, he started vomiting violently, and releasing nothing but water in his faeces.

Ammad’s mother, Amna, says they live in E-Market, an area near Nursery (Sharea Faisal), and ever since the rains, the family has been receiving water with a strange chemical taste.

“I don’t know why, but it tasted like DettolÆ,” she says making a face. “I wasn’t there at the time another child in the house gave my son tap water. We always boil the water before drinking it, but the kids didn’t know,” she says.

Amna has already faced a tragedy once before when two years ago her daughter died of the same disease.

Her eyes show no emotion as she speaks but it is not because she is not sad. It is because she has almost accepted the fact that she has to be prepared to maybe lose another child. She opines because she does not have contacts that makes it more difficult for her to receive any good treatment for her child.

“The last time my daughter Aiman was here, my husband knew a man Imran who worked here. Although she could not be saved, Imran did the best he could for us. Now no one is very cooperative in this place. The last time the doctor came was at 9:00 am to attach a drip to my son’s arm. It’s been six hours now and not a single person has come to check up on him.” A slight note of anger tinges her voice as she talks about it.

Amna explains that the attendants, who were sent to attach the drip to her son, were violently prodding him on his arms and feet and seemed absolutely incapable of doing their job.

“At least they should realize they are handling a child,” she says as annoyance marks her quiet voice, “They just tried to poke him almost anywhere they could find with the needle,” she points almost hatefully to a bottle of Ringolact (Lactated Ringer’s) hanging on the drip stand, with the needle at its other end piercing Ammad’s delicate skin.

It is not a coincidence that the Gastro Ward is filled with only children aging one to two years. Gastroenteritis is one of the most deadly diseases that usually occurs among infants, especially in developing countries. This mainly depends upon the feeding and living conditions of the infant and also upon whether the water consumed is contaminated or not.

In Karachi, almost all areas, especially the poorer localities are the worst hit by this disease. Children are often seen splashing around in the water accumulated on the roads, most of which is stagnant water, serving as a breeding ground of mosquitoes, flies and disease-carrying pathogens. Some are even seen playing in the water running through the waterways in the city, which is clearly mixed with sewage water. With lack of education, parents do not realize that this is an invitation to death. But besides this, the unfortunate fact is that even the water running through the pipe lines, meant for consumption, is more than often contaminated, mixed with sewage water and noxious chemicals, and this water is not only used for bathing but even for drinking. There are very few people who boil water for drinking purposes.

Dr Ejaz Tunio, who works at the NICH, says that the gastro cases have increased immensely after the heavy rains in Karachi as they do every year.

“If we got 100 cases in the Emergency OPD before the rains, we are getting around 200 more now. But there have been other rain-related problems with children, including head injuries and fractures through slipping. But for those we have taken CT scans and X-rays and have forwarded the cases to JPMC. We haven’t had mortalities in NICH at least, but it is true that some cases of injuries have been serious.”

Rizwana, who lives in Sachchal Goth, says her child has been ill since Thursday last week, and although she has been boiling water, the water running through the pipe lines in her house must be so dangerous that even boiling it did not help.

Belonging to a poor family that lives in Ibrahim Hyderi, she says it is a relief that NICH is not charging her for doctors’ fee or anything else, except the medicines and the injections that she has to buy from outside. But she does complain about the lack of help from any kind of organization or the government to help the poor protect their children. She says it costs at least Rs 350 per drip, and it is almost insane, she says, how she and her husband are managing to spend on the medicines, the drips, the vaccines and the pampers, besides the money needed for food and other domestic expenditures. But this is a woman who still works as a sweeper in a house.

Rubina does not work, because she has seven children, and she shows her light brown eyes, patched dark like a raccoon’s from crying and staying awake all night.

“I don’t know what to do in order to tell the authorities that I don’t even have enough money to save my child’s life. I lost my son two months ago to the same disease. Now my other son is losing his life, lying there in high fever and I’m just borrowing from people to pay for my medicines. How do I say to those on topÖI want to tear my heart out in front of them and tell them what I’m feeling, but no one will listen. Can’t they just stop building bridges and just give us free medicines instead?”


Total cases in Karachi: 887 (99 percent gastro; others include skin diseases, etc)

Admitted in hospitals: 52 (in OPDs)

Rest of Sindh -Cases recorded: 923 (268 admitted in OPDs)

Number of deaths: 1 (dengue fever)

(Statistics are recorded every 24 hours)

(By Xari Jalil, The News-14, 04/07/2007)

ASH gets lithotripsy machine

KARACHI, July 4: The city government has installed a lithotripsy machine worth Rs28.6 million at the Abbasi Shaheed Hospital with the help of two German engineers.

The machines are also available at the Jinnah Postgraduate Medical Centre and Civil Hospital Karachi. However, ASH is the first hospital being run by the city government where such a machine has been installed.

The German engineers, Davide Vinzi and Jorg Kaiser, were providing technical training to the hospital staff about the functioning of the machine.

The lithotripsy machine is used to fragment and disintegrate kidney stones through high-energy shock waves.

(Dawn-18, 05/07/2007)

Dengue fever once again

IT appears that Karachi will once again have to brace itself for a possible outbreak of dengue fever. Viral haemorrhagic fever, a more lethal form of the disease, has already claimed two lives in the last three weeks. As hospitals start taking in patients suffering from suspected dengue fever, there are fears of a repeat of the situation last year when the disease claimed 50 lives while hundreds tested positive for the virus. With the onset of the rainy season, pools of stagnant water — the ideal breeding ground for mosquitoes — are once again visible in several areas of the city, with no signs of their being drained. It is also not clear how prepared hospitals in the city are to cope with another outbreak of the disease, especially as many lack the required diagnostic and treatment facilities. Dengue fever may be self-limiting in most patients, but complications can prove fatal if hospitals are not equipped to handle cases where blood transfusion is needed.

Going by last year’s poor disease management by the authorities, there is every reason to be skeptical of the government’s level of preparedness this year. However, the people, too, must be faulted for not adapting basic measures to protect themselves from mosquito bites. Apart from applying insect repellent and wearing long-sleeved clothing, people should be wary of exposed standing water in and around their homes, in potted plants and uncovered containers. Such safeguards should be promoted through the media and regular government campaigns. Not only will this prevent the spread of dengue fever, other vector-borne diseases like malaria, too, can be warded off. Precautionary measures at the government and community levels must be taken now before hospitals are flooded with dengue cases.

(Dawn-7, 06/07/2007)

Doctors raise alarm over dengue fever outbreak
KARACHI, July 5: Fearing the spread of dengue fever – also known as viral haemorrhagic fever in technical parlance – in the city in the coming weeks, the Karachi chapter of the Pakistan Medical Association (PMA) has urged the government to intensify its efforts against the much-dreaded disease at all levels.

The appeal came after cases of suspected dengue fever started arriving at different hospitals following the recent rains and at least two confirmed dengue patients died at a private hospital in the last three weeks or so.

A senior doctor at the Liaquat National Hospital told Dawn on Thursday that about 30 people with suspected VHF were brought to the hospital in June and nine of them were tested positive. One of the nine patients had expired at the hospital only last week, the doctor added.

Health officials said that some more suspected VHF cases were reported at a few hospitals and clinics in the city last month.The PMA suggested launching of concerted efforts by all civic agencies and cantonment boards at the levels the federal, provincial and district governments without any delay to eliminate the species of the mosquito responsible for VHF, from all parts of Karachi.

It also laid emphasis on the need for a massive awareness campaign to be run on a regular basis, besides effective fumigation to be carried out at regular intervals. It identified the places requiring fumigation, pointing out that puddles of stagnant water on roads and streets – especially those around hospitals, schools, offices, nurseries, parks – become a breeding ground for mosquitoes.

In a statement, PMA General-Secretary Dr S.M. Qaiser Sajjad said that the association had already sounded an alert following an increase in the number of dengue cases after the rains in the city.

He recalled that dengue fever had claimed 52 lives in Karachi while more than 7,000 people had reported having contracted the virus across the country last year.

The PMA also urged the government to set up quality laboratories at major public sector hospitals in Karachi where poor people could avail themselves of the facility of diagnosis of various viruses.

(Dawn-17, 06/07/2007)

Rise in Hepatitis C

THE results of an informal survey conducted by the Prime Minister’s National Programme for Prevention and control of Hepatitis and the Punjab health department are disturbing. Out of 34 districts in the province, including Lahore, 30 face a serious threat of Hepatitis C. This is not good news for the programme that was launched two years ago and, despite many promises about providing medicines and screening tests, does not have much to show for its success. An increase in Hepatitis B cases has been found in D. G. Khan, Muzaffargarh, Multan and Bahawalnagar which too calls for speedy preventive and curative measures. These are life-threatening diseases and for Hepatitis C, no real cure has been found so far. There has been some breakthrough in treatments abroad but these must be very expensive. The government must explore ways in which patients afflicted with the disease can best be treated for it is ultimately its responsibility to care for its people. It must also ensure that blood screening tests, vaccinations and treatment is provided, particularly in the rural areas where healthcare is lacking. This is not an illness that can be “treated” by quacks so the health department has to dispatch doctors to remote areas so that they can treat the poor.

There are however many steps that can, and should, be taken by the health authorities. For starters, awareness on the blood-borne diseases must be raised. A lack of it is largely responsible for the large number of hepatitis B and C patients, once estimated to be ten million by the World Health Organisation. A big contributing factor is medical malpractice like the reuse of syringes, which also spreads Aids. People must know the dangers of this and their safe disposal must be strictly monitored at hospitals. The government cannot afford to be complacent on this score.

(Dawn-7, 12/07/2007)

PMDC earns doctors’ ire over ‘violation of rules’

KARACHI, July 11: The Pakistan Medical Association (PMA), Karachi chapter, on Wednesday strongly condemned the Pakistan Medical and Dental Council (PMDC) for ignoring its own rules and regulations.

The PMDC, in its 108th session, which was dominated by private institutions, made decisions in favour of those institutions that had been found deficient by the inspection team. The reports of the inspection team for 40 institutions were not presented in the council meeting. Even then the council recommended their recognition, a PMA release said.

The presentation report of the inspection team for every institution is mandatory under the PMDC rules and regulations.

This is the second time that the council has taken an illegal decision in the absence of a large number of representatives from major medical institution like the College of Physicians and Surgeons of Pakistan, Jinnah Post-Graduate Medical Centre, National Institute of Cardiovascular Diseases, National Institute of Child Health, Army Medical College, Post-Graduate Medical Institute Lahore, Post-Graduate Medical Institute Peshawar, Ayub Medical College, Balochistan University, Peshawar University, Punjab University, Shaikh Zayed Medical College and others.

In fact they were not even invited for this meeting to avoid any objection, the statement added.

The PMA Karachi appreciated the reaction shown by the PMA Punjab and said it would support its actions against the PMDC irregularities.

It also believed that all the council members of the PMDC from different medical institutions of the country who were not invited nor consented for the PMDC meeting should raise there voices and protest against the illegal decision.

“If these types of illegal decisions continued unabated, then very soon qualified quacks would be seen playing with the health of the citizens all over Pakistan,” it said, adding that already approximately 650,000 quacks were playing with the lives of innocent people across the country.

The PMDC should be a strong autonomous body for the betterment of the medical institutions to produce good quality, trained and patient-friendly doctors, who can benefit ailing people, the release concluded.

(Dawn-17, 12/07/2007)

Men’s role in women’s health

IN a patriarchal society such as ours, little progress can be made on maternal health without the support of male family members. Appropriately then, the theme for this year’s World Population Day, observed on Wednesday, was “Men as partners in maternal health”. But such a slogan rings hollow in societies where decision-making by women is circumscribed to an extent where they are not even allowed a say in the number of children they want to bear. With an average fertility rate of 4.3 — greater in the rural areas — the number of children per woman is among the highest in the region. Early marriages, gender discrimination and poor accessibility to health and contraceptive services have complicated the issue for women whose destiny is decided by husbands, fathers, brothers and male community and religious leaders who formulate public opinion. Maternal mortality in the country is in the vicinity of 350 to 500 per 100,000 live births, indicating that reproductive health needs are largely ignored. Under such circumstances, it is essential to create an environment where women are encouraged to take decisions about the size of their families and men are urged to support them in their role as heads of families, breadwinners and managers of community resources.

How this can be achieved is another story. The task will be gargantuan no doubt, given the prevailing anachronistic notions on birth control and the perception of women as inferior beings. It will call for a total change in outlook, and the government will have to do all it can to lessen gender disparities and give women a more prominent role in decision-making. Religious and community leaders, too, can play their part as moulders of public opinion, and the relevant authorities should induct them in any campaign aimed at disseminating information about reproductive health.

(Dawn-7, 13/07/2007)

New morgues, funding for health care units soon
KARACHI, July 12: Just 13 of the 36 maternity homes run by the City District Government Karachi (CDGK) are functional, while 61 healthcare facilities remain inoperative because of financial and administrative difficulties.

This was announced by the executive district officer (health) of the CDGK, Dr A.D. Sajnani, at the Sindh Government Children Hospital on Thursday. He said that the non-functional maternity homes lacked staff and equipment while the healthcare units suffered because of a ban on the appointment of doctors and paramedical staff, as well as the lack of funding. However, he added that the provincial government has allocated Rs20 million for this purpose in its new budget.

Mr Sajnani said that work on five morgues had been initiated and the tenders would shortly be finalised. These will be established on the premises of the New Karachi, Abbasi Shaheed and Ibrahim Hyderi hospitals, Landhi Medical Complex and one additional location that is yet to be decided, and will provide free-of-cost cold-storage facilities to 100 bodies each. He added that there is currently no such facility in the government sector, and the Edhi Foundation’s morgue is often over-loaded.

Confirming the his department has stopped issuing new licenses to medical stores for the sale of drugs, Mr Sajnani said that the special secretary (public health) of the Sindh Health Department has verbally requested this. “There is tremendous pressure from applicants but we are not in a position to issue new licenses, in line with a decision taken at the Sindh Governor’s House a couple of months ago,” he said. On March 24, the governor of Sindh, Dr Ishrat-ul-Ibad, ordered a province-wide ban on new licenses for medical stores or chemists until a strategy is evolved to enforce the Federal Drug Act.

Taking note of the reported sale of fake drugs, Dr Ibad had asked the relevant quarters to prepare a strategy in a week’s time. Asked about this, Dr Sajnani said that he had been told that a draft policy had been prepared by the provincial health department and had been passed on to the law department for vetting.

(Dawn-19, 13/07/2007)

250 ambulances for 15m people
In a city of almost 15 million, there are only 250 ambulances. That makes it almost 60,000 people to one ambulance. What is worse is that most of these are private ambulances run by social welfare organizations. For all practical purposes, the government has abdicated from its role to provide this essential service in Karachi.

What makes it worse is that many of these ambulances are in poor condition without basic facilities like oxygen cylinders or first aid apparatus. This puts the lives at risk every day while the government looks the other way.

A survey conducted by The News revealed that about five percent ambulances in Karachi are equipped with that necessary items which are generally considered an essential part of any ambulance in the modern world.

It may be added that in Karachi, an average of 10 people are victims of road accidents daily and are brought dead to different public sector hospitals. In addition, 20 to 30 injured persons are brought to hospitals daily. Most of these are brought on ambulances run by the social welfare organisations.

These organisations run their affairs with the cooperation of philanthropists. Their donations help these organizations to provide ambulance services and numerous other facilities to the public.

The Edhi Welfare Trust, which has the largest ambulance network service in the country, has 100 small and 50 big ambulances in Karachi alone. In addition, the Chippa Welfare Organization has 25 ambulances operating in Karachi. The Red Crescent (Hilal-e-Ahmar) has 12 ambulances which operate throughout the Sindh Province.

The ambulances of the Red Crescent organization seem to be the best equipped in the city but are not pressed into service as often as others. Most of the ambulances are four-wheel drive vehicles. In addition, the Hilal-e-Ahmar has the only functional cardiac ambulance in the city. This ambulance is equipped with ECG, BP apparatus and oxygen cylinders.

Properly equipped ambulances are rare in the city. The majority of Edhi and Chippa ambulances are Suzuki Hi-Roof vans which are poorly equipped. They are also rashly driven by poorly paid and overworked drivers.

However, these smaller ambulances are considered as the best choice for the heavy traffic of Karachi to transport the patients to hospitals from the different parts of the city. In addition, two private organizations - Qadir Khan Mandukhail has two ambulances and Al-Azam Welfare Trust has eight. But these are used to carry patients out of Karachi in most instances.

The irony is that the major public sector hospitals of the city barely have a couple of ambulances each. Most of these ambulances are in a poor state of maintenance and are rarely used for the public.

Lyari General Hospital, Sindh Government Hospital New Karachi, Sindh Services Hospital, NICH, Cardio Hospital and Abbasi Shaheed have their own ambulances. But most are in poor working order.

The Jinnah Post Postgraduate and Medical Centre has 12 ambulances but these are used to transfer patients to different wards within JPMC. One of JPMC ambulances is equipped with life saving equipment and two are equipped with necessary items which are needed to handle emergency.

The rest of the ambulances have only stretchers. These ambulances are also used to transport patients to other laboratories outside the hospital for conducting certain tests not done at JPMC. In addition, many private hospitals also have their ambulances but these are not used for city emergencies.

The city’s already scarce ambulances are also pressed into work for other purposes. During bomb hoax calls, ambulances are also called on the spot and made to stand by at great cost to the general public.

While charges for the private ambulances are reasonable, there are numerous complaints on service. Edhi ambulances charge Rs50 for every 10 kilometer. Chippa Welfare Organization charges Rs100 for each 10 kilometers.

Chippa has 75 ambulance drivers who work round the clock. Chairman, Chippa Welfare Organization, Muhammad Ramazan Chippa estimates that his organization needs 175 more ambulances to deal with accidents and emergency like situations in the city.

Many people who availed the services of these ambulances claim with bitterness that they were literally blackmailed at the hands of ambulance drivers. They said besides the transportation charges of patients, they are also asked to pay “lifting charges” of patients as well.

But there are some organizations that say they take public complaints seriously. Transport Officer of Red Crescent, Abdul Jabbar Qabulio, said that his organization has transparent system of charging. He said Rs18 per kilometer are charged for a Pajero ambulance, Rs12 for Toyota Hiace and Rs25 per kilometer for the cardio ambulance. He said any driver who receives more charges from the public could be suspended.

What is sad is that both the Sindh government and the CDGK do not have a fleet of emergency ambulances for the city. There is also no system in place to coordinate ambulance activity, which is done in other cities around the world. At a time when the Punjab government has set up an emergency response system with a fleet of state of the art ambulances, the absence of such a service in Karachi leaves a gaping hole in the work of the government. Many people ask where government funds are going if there is nothing for such essential services of the city.

(By Qadeer Tanoli, The News-13, 17/07/2007)

Poor care at JPMC
Due to uncooperative attitude of doctors at the Jinnah Postgraduate Medical Centre (JPMC), relatives of blast victims brought here had to suffer needlessly after being processed in the emergency ward. The post-emergency ward care was almost non-existant said many.

Many had to look for doctors and nurses for care after being treated and shifted to other wards of the hospital. In one instance, Muhammad Naeem, hailing from Pishin, a pushcart vendor at Hub Chowki, was injured in different parts of his body owing to shrapnel. He was brought to JPMC after the blast where he was provided first aid at the emergency ward. After this, he was shifted to Ward 14. One of his legs was badly injured and he had several injuries in his chest. He was also injured in one eye.

When this scribe visited the patient at the hospital, he was completely unconscious. Relatives of the victim said that after the admission of the victim at Ward 14, they attempted lot to get some doctor for him but in vain. They said that whenever the victim talked, he complained about some movement in his chest.

This reporter found no doctor at the ward to attend to this seriously injured person. Only a nurse was looking after all the matters of the whole ward. The nurse told the relatives of the victim to approach the emergency ward, as the orthopedic doctors would be available there and would provide all information. The relatives of the victim along with this reporter visited the orthopedic section of emergency ward.

The doctors deputed there were not able to tell them who would be responsible to look at their patient. The duty person there asked the bewildered relatives to approach the Causality Medical Officer (CMO) for “further information.”

It was their bad luck that the CMO was not present at the emergency ward at that time. The relatives were also told to wait for the doctor to come and that it was “not their problem” as the patient had already been shifted out of the emergency ward.

(By Qadeer Tanoli, The News-13, 20/07/2007)

Waterborne diseases claim 1.2m lives
KARACHI, July 22: Around 1.2 million people, including 250,000 children below five years of age, die of waterborne diseases every year in the country.

This was observed by doctors at a programme on waterborne diseases organized by the scientific sub-committee of the Pakistan Medical Association on Saturday.

According to them, three million people suffer from waterborne diseases annually and the loss of precious lives and its consequent socio-economic cost can be avoided only if supply of clean water is ensured and simple hygiene practice is adopted by people. The doctors said that waterborne diseases like cholera, typhoid, gastroenteritis, hepatitis A and E had become a major problem in the country as water supply and distribution system had become obsolete and the quality of the so-called mineral water of 118 brands available in the market had been found below the standard.

However, what perturbed one of the participating family physicians, Dr Ross Masood Ahmed, more was the lack of awareness among general public about basic hygiene. He said, “Besides the government indifference towards the issue, lack of concern about hygiene among people particularly among the lower economic strata of society was worrying,” he added.

Dr Ahmed warned against use of ground water that contained certain chemicals, which could cause skin infections and hair loss. “The ground water in the old city areas is extremely dangerous while it is slightly better in Malir, Landhi and other suburbs,” he said, observing that the ground water even after being boiled is not purified completely. He said tap water should be boiled in a stainless steel container, which was the most effective method to disinfect water. “The widely-used water filters kill bacteria but not viruses,” he remarked.

He also underlined the need for creating awareness about the hazards of junk food.

Starting off her presentation with the world statistics about waterborne diseases, Dr Afia Zafar of Aga Khan University’s pathology department said about four billion episodes of diarrhoea resulted in an estimated two million deaths, mostly among children, every year. Waterborne bacterial infections may account for as many as half of these episodes and deaths, she added.Many deaths, she said, among infants and young children were due to dehydration, malnutrition, or other complications of waterborne bacterial infections. “Infection does not transmit only from consumption of contaminated water but also from exposure to contaminated water. Person-to-person transmission can take place if there is poor sanitation,” she said. She also advised people to avoid drinking the water and beverages with ice of unknown purity and uncooked/unpeeled vegetables or fruits.

PMA General-Secretary Dr Qaiser Sajjar said the high mortality and morbidity owing to waterborne diseases reflected the apathy of civic agencies. The government must fulfill its basic duty and ensure provision of safe drinking water to everyone, he said.

Journalist Zubeida Mustafa stressed the need for health education and better ties between the media and medical fraternity to address the issue.

(Dawn-13, 23/07/2007)

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