KARACHI: Health services being provided to 600,000 children in government schools in Karachi are likely to come to an end, like in the interior of Sindh, according to reliable sources.
A decision to this effect was taken in a cabinet meeting. In fact, the downsizing has already begun, as the number of doctors in school health services, which was 430 two years ago, has been reduced to 260 and there is now one doctor to 1,500 children.
Doctors and school principals have strongly objected to the decision. “Instead of expanding the services to cover all government schools, including those in areas like Lyari where they are most needed, the government is withdrawing the facilities. This will be a great injustice to the poor children. Why can’t the government, instead, increase the budget.”
One of the benefits of the health services has been its preventive aspect: it catches a disease at a primary stage before it is fully blown, as schoolchildren are subjected to a general checkup — their weight and height are recorded, teeth and eyes checked and special complaints attended to. Each child, then, gets a health card which indicates his ailment, if any.
It was during such a process that Dr Soofiya and her two colleagues, who attended to 850 children in Sharafabad School, detected more than ten children with lockjaw or mucous fibrosis, a precancerous condition in which the capacity to open the mouth becomes restricted. “This is because the children had been eating several packets of supari every day. When I explained to them the consequences in case they didn’t stop eating supari, some of the children had tears in their eyes. Then I gave them some mouth exercising tips and asked them to chew gum,” she said.
However, a common health problem among the children noted by doctors working in these government schools across the city is anaemia.
According to Dr Robina Baloch, who is posted in the Government Boys Primary School in Bazarta Line area (behind Aisha Bawany School), “this usually occurs due to the presence of worms in the stomach, because of drinking unboiled water”. For this, she prescribes folic acid and gives each kid a weekly dose of pills.
She has also observed a surprisingly large number of children with stunted growth rate due to malnutrition. But when she writes to the parents, many of whom are tailors, hawkers and cart- pushers, they rarely respond “due to personal problems and overwork”. She then gives such children a weekly count of vitamin pills and refers serious cases to the JPMC.
Dental caries is also common. Dr Mahesh, a dentist, who once attended to 200 children of Shah Abdul Latif Bhitai School, Lyari, and is now posted in a school in Saddar, observes that tooth-brushing is not a regular habit among children. “We need to teach them how to brush their teeth.” He has found that more than 30 per cent of students at 14 years of age suffer from bleeding gums and dental caries.
Children also tend to suffer from weak eyesight. Dr Razia Babar, who is posted in the Government Girls Secondary School, Liaquatabad, where 900 students are enrolled, holds a daily OPD.
“I find many children with weak eyesight due to wrong reading habits and poor nutrition. They need to be told what to do so that their eyesight does not get worse.”
Among the less common problems observed is “scabies”, noted by a doctor in a school near Cattle Colony. This was also observed by Dr Ruby Qureshi of the Government Norvision School in Azam Basti. She also found that a number of children had lice in their hair.
As many health problems occur due to lack of hygiene, several doctors educate children about cleanliness measures in their class lectures. Dr Arifa also makes it a point to talk about the monthly cycle to girls as “many are not close to their mothers”. She also tells them about other common problems.
“Last month, I gave a talk on tetanus and warned them what can happen at childbirth if the instruments are not sterilized.”
There is no doubt that doctors in schools are imparting health awareness among children. This is why school principals, like Najma Parveen of Hyderi Modern Government Boys School, insist that school health services should continue at all cost. But it is also true that doctors associated with these services face great problems, one of which is the limited availability of medicines. According to the deputy-director, Health Services, Dr Asif Zaman, the government provides Rs400,000 for the health care of 600,000 children, which is just 75 paisas per child.
He also draws attention to the limited number of paramedics. “When the health services began in 1954, there were 18 paramedics and 18 doctors. Over the time, the number of doctors has been increased to 260, but that of the paramedics has remained the same - just 18.”
The lack of paramedics means that the doctors - majority of whom are female - have to shoulder all the work, that of a dispenser and even a cleaner. Sometimes, they also have to run errands - such as drive to the central office on M.A. Jinnah Road to fetch medicines once the supply is exhausted.
As to the complaints that some of the doctors do not perform their duties properly, he says, “Every doctor has to submit a regular progress report signed by the principal, the only person who can monitor their work daily”. Besides, he says, these doctors conduct door-to-door polio campaigns in the city after every two or three months, hold medical camps when needed and come to the aid of the people in times of emergencies, such as floods, etc.
As for the doctors, a common complaint is about poor working conditions. A number of doctors said they had not been provided with the needed medical equipment, furniture, stationery and even a separate room. In this regard, the doctors working in Sharafabad School have been fortunate. A philanthropist paid for the five chambers built for them, including the furnishings and some equipment.
Some doctors also resent the door-to-door polio campaign that they have to carry out. “It is very tiresome to climb several flights of steps in flats with no elevators. I think medical students, who are eager to volunteer, should run the campaign,” said one doctor.
She also felt that these duties, which took about two weeks every two months or so, disrupted their school activities. However, what irks most doctors is the uncertainty of their work in schools. “Since three years it has been said that the school services would be closed. How can we attend to our work with this in mind?”
The doctor also pointed out that whereas in the West, school health services were being strengthened because they were seen as the best way to check certain diseases, here the plan was to do away with such services altogether. “This will only hurt the poor who need such services the most. But the government is least concerned,” she observed.
